Provider Demographics
NPI:1568705366
Name:WRIGHT, RICHARD (LPC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:AZ
Mailing Address - Zip Code:86025-2817
Mailing Address - Country:US
Mailing Address - Phone:928-524-6701
Mailing Address - Fax:928-524-3068
Practice Address - Street 1:2500 E SHOW LOW LAKE RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7994
Practice Address - Country:US
Practice Address - Phone:928-537-2951
Practice Address - Fax:928-537-4841
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2015-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC14157101YM0800X
AZLPC - 15744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health