Provider Demographics
NPI:1417519893
Name:WRIGHT, MICHELLE (MS LPCC, SCHOOL PSY)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MS LPCC, SCHOOL PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11681 VOYAGER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921
Mailing Address - Country:US
Mailing Address - Phone:719-260-2282
Mailing Address - Fax:
Practice Address - Street 1:11681 VOYAGER PARKWAY
Practice Address - Street 2:SUITE 150
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921
Practice Address - Country:US
Practice Address - Phone:719-344-9342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0109888101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CONLC0109888OtherOTHER