Provider Demographics
NPI:1326594557
Name:WRIGHT, LARAE SHANETT (AMFT, APCC,RADT-1)
Entity Type:Individual
Prefix:
First Name:LARAE
Middle Name:SHANETT
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:AMFT, APCC,RADT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 E MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3009
Mailing Address - Country:US
Mailing Address - Phone:707-469-4540
Mailing Address - Fax:707-469-4560
Practice Address - Street 1:1119 E MONTE VISTA AVE
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3009
Practice Address - Country:US
Practice Address - Phone:707-469-4540
Practice Address - Fax:707-469-4560
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT127516106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist