Provider Demographics
NPI:1326359803
Name:WRIGHT, HILLARY SUZANNE (MDIV, PHD)
Entity Type:Individual
Prefix:DR
First Name:HILLARY
Middle Name:SUZANNE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MDIV, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25335
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-0335
Mailing Address - Country:US
Mailing Address - Phone:310-633-1295
Mailing Address - Fax:
Practice Address - Street 1:10436 SANTA MONICA BLVD STE 3005
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6934
Practice Address - Country:US
Practice Address - Phone:310-633-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 27196103TC0700X
NY021128103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB233928OtherMEDICARE ID