Provider Demographics
NPI:1609420934
Name:WRIGHT, LAURIE LEE (NRA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:LEE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:NRA
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:LEE
Other - Last Name:STARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3587 HEATHROW WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4004
Mailing Address - Country:US
Mailing Address - Phone:541-858-8170
Mailing Address - Fax:541-858-8167
Practice Address - Street 1:3200 JUANIPERO WAY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8580
Practice Address - Country:US
Practice Address - Phone:541-816-4131
Practice Address - Fax:458-226-2163
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANAOO178502Medicaid