Provider Demographics
NPI:1851027684
Name:WRIGHT, TERESA MARIE (QMHP, QIDP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:QMHP, QIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMINEE
Mailing Address - State:MI
Mailing Address - Zip Code:49858-3009
Mailing Address - Country:US
Mailing Address - Phone:906-863-7841
Mailing Address - Fax:906-863-2833
Practice Address - Street 1:401 10TH AVE
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858-3009
Practice Address - Country:US
Practice Address - Phone:906-863-7841
Practice Address - Fax:906-863-2833
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803087256104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker