Provider Demographics
NPI:1740240845
Name:WRIGHT, DONNA GAY (LPC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:GAY
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1654
Mailing Address - Country:US
Mailing Address - Phone:903-504-5685
Mailing Address - Fax:903-787-8845
Practice Address - Street 1:734 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1654
Practice Address - Country:US
Practice Address - Phone:903-504-5685
Practice Address - Fax:903-787-8845
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165309901Medicaid