Provider Demographics
NPI:1679899322
Name:WRIGHT, BRIAN
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CHEROKEE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5600
Mailing Address - Country:US
Mailing Address - Phone:580-340-7235
Mailing Address - Fax:580-324-6324
Practice Address - Street 1:300 W CHEROKEE AVE STE 102
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5600
Practice Address - Country:US
Practice Address - Phone:580-340-7235
Practice Address - Fax:580-324-6324
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health