Provider Demographics
NPI:1376908848
Name:WRIGHT, NICHOLAS ALEXANDER (LMSW, MDIV)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ALEXANDER
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LMSW, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9904 ADOBE CT
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8960
Mailing Address - Country:US
Mailing Address - Phone:254-749-1279
Mailing Address - Fax:
Practice Address - Street 1:9904 ADOBE CT
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8960
Practice Address - Country:US
Practice Address - Phone:254-749-1279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60740104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker