Provider Demographics
NPI:1306034426
Name:WRIGHT, KIMBERLY (LMHC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 NORTH WAYNE ST. PMB 143
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-1522
Mailing Address - Country:US
Mailing Address - Phone:260-665-6543
Mailing Address - Fax:260-665-6535
Practice Address - Street 1:408 NORTH WAYNE ST. PMB 143
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1522
Practice Address - Country:US
Practice Address - Phone:260-665-6543
Practice Address - Fax:260-665-6535
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001897A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201035220AMedicaid