Provider Demographics
NPI:1700368073
Name:WRIGHT, HERBERT BURRELL
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:BURRELL
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 1:335 E ALBERTONI ST # 200-410
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1425
Mailing Address - Country:US
Mailing Address - Phone:909-693-0441
Mailing Address - Fax:
Practice Address - Street 1:335 E ALBERTONI ST # 200-410
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1425
Practice Address - Country:US
Practice Address - Phone:909-693-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141767106H00000X
CA107793106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist