Provider Demographics
NPI:1659388809
Name:WRIGHT, JARVIS A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JARVIS
Middle Name:A
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W CONCHO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-6310
Mailing Address - Country:US
Mailing Address - Phone:392-944-8184
Mailing Address - Fax:392-658-3318
Practice Address - Street 1:421 W CONCHO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6310
Practice Address - Country:US
Practice Address - Phone:392-944-8184
Practice Address - Fax:392-658-3318
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-1582103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00EC01Medicare ID - Type UnspecifiedMEDICARE