Provider Demographics
NPI:1851684625
Name:WRIGHT, STEPHEN M (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8615 LIBERTY GROVE DR.
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480
Mailing Address - Country:US
Mailing Address - Phone:708-785-8688
Mailing Address - Fax:
Practice Address - Street 1:8615 LIBERTY GROVE DR.
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480
Practice Address - Country:US
Practice Address - Phone:708-232-8876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006958101YP2500X
IL180008367101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional