Provider Demographics
NPI:1518464221
Name:WRIGHT-EVANS, SAVANNAH
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:WRIGHT-EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12665 FALCON DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-3219
Mailing Address - Country:US
Mailing Address - Phone:719-283-1406
Mailing Address - Fax:719-249-5834
Practice Address - Street 1:12665 FALCON DRIVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-3219
Practice Address - Country:US
Practice Address - Phone:719-283-1406
Practice Address - Fax:719-249-5834
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-44363103K00000X
CABCBA-1-20-44363103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARBT-18-52949Medicaid
CABCBA-1-20-44363OtherBCBA