Provider Demographics
NPI:1760704142
Name:WRIGHT, ANGIE DENISE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:DENISE
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 1:720 N. COMMERCE
Mailing Address - Street 2:STE #634
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401
Mailing Address - Country:US
Mailing Address - Phone:580-795-4844
Mailing Address - Fax:575-267-6243
Practice Address - Street 1:720 N. COMMERCE
Practice Address - Street 2:STE #634
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-795-4844
Practice Address - Fax:575-267-6243
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK5433101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200342320BMedicaid