Provider Demographics
NPI:1114313533
Name:WRIGHT, SUSAN (MFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 COYOTE STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:916-207-4873
Mailing Address - Fax:
Practice Address - Street 1:505 COYOTE ST
Practice Address - Street 2:SUITE C
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2245
Practice Address - Country:US
Practice Address - Phone:916-207-4873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81847106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist