Provider Demographics
NPI:1558375360
Name:WRIGHT, MADELINE (MS LLP)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MS LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17177 N LAUREL PARK DR
Mailing Address - Street 2:SUITE 131
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2693
Mailing Address - Country:US
Mailing Address - Phone:734-462-3210
Mailing Address - Fax:734-462-1024
Practice Address - Street 1:17177 N LAUREL PARK DR
Practice Address - Street 2:SUITE 131
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2693
Practice Address - Country:US
Practice Address - Phone:734-462-3210
Practice Address - Fax:734-462-1024
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012382103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI$$$$$$$$$OtherSOCIAL SECURITY