Provider Demographics
NPI:1124228309
Name:WRIGHT, WILMA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WILMA
Middle Name:J
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6085 COUNTY ROAD 743
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-7105
Mailing Address - Country:US
Mailing Address - Phone:573-934-6338
Mailing Address - Fax:573-624-1985
Practice Address - Street 1:6085 COUNTY ROAD 743
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-7105
Practice Address - Country:US
Practice Address - Phone:573-934-6338
Practice Address - Fax:573-624-1985
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0002371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497776112Medicaid