Provider Demographics
NPI:1275748287
Name:WRIGHT, LISA A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
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 1:4662 GREENS PRAIRIE TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-2351
Mailing Address - Country:US
Mailing Address - Phone:443-340-5136
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:4662 GREENS PRAIRIE TRL
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-2351
Practice Address - Country:US
Practice Address - Phone:443-340-5136
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX509591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical