Provider Demographics
NPI:1093034878
Name:WRIGHT, ANDREW KEITH (MED, LSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:KEITH
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MED, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2140
Mailing Address - Country:US
Mailing Address - Phone:740-532-7855
Mailing Address - Fax:740-532-0557
Practice Address - Street 1:1518 S 3RD ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2140
Practice Address - Country:US
Practice Address - Phone:740-532-7855
Practice Address - Fax:740-532-0557
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0000316101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH09425Medicaid