Provider Demographics
NPI:1699036079
Name:WRIGHT, JOSEFA GABRIELLE
Entity Type:Individual
Prefix:
First Name:JOSEFA
Middle Name:GABRIELLE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9621 AUTUMN SHADE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-1934
Mailing Address - Country:US
Mailing Address - Phone:210-551-2889
Mailing Address - Fax:
Practice Address - Street 1:9621 AUTUMN SHADE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254
Practice Address - Country:US
Practice Address - Phone:210-551-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-02
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional