Provider Demographics
NPI:1851047229
Name:WRIGHT, KARISSA BETH (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:KARISSA
Middle Name:BETH
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4800
Mailing Address - Country:US
Mailing Address - Phone:269-215-9397
Mailing Address - Fax:
Practice Address - Street 1:12330 JAMES ST STE A80
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8581
Practice Address - Country:US
Practice Address - Phone:616-757-7572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011094701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty