Provider Demographics
NPI:1558620534
Name:WRIGHT, TODD ALLEN (MED)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALLEN
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MISSION WALK CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-6524
Mailing Address - Country:US
Mailing Address - Phone:314-706-4227
Mailing Address - Fax:
Practice Address - Street 1:4507 LACLEDE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2103
Practice Address - Country:US
Practice Address - Phone:314-706-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011030508101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional