Provider Demographics
NPI:1780035154
Name:WRIGHT, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
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:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32772-0160
Mailing Address - Country:US
Mailing Address - Phone:321-696-2216
Mailing Address - Fax:
Practice Address - Street 1:740 FLORIDA CENTRAL PKWY
Practice Address - Street 2:STE #1028
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-7651
Practice Address - Country:US
Practice Address - Phone:407-774-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor