Provider Demographics
NPI:1932311537
Name:WRIGHT, KELLY J (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:J
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2501 W. ASH
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4609
Mailing Address - Country:US
Mailing Address - Phone:573-446-9665
Mailing Address - Fax:573-446-9757
Practice Address - Street 1:2501 WEST ASH ST
Practice Address - Street 2:A
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4609
Practice Address - Country:US
Practice Address - Phone:573-446-9665
Practice Address - Fax:573-446-9757
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005029334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional