Provider Demographics
NPI:1992389654
Name:WRIGHTMIRE, KEIGHT (MSW)
Entity Type:Individual
Prefix:
First Name:KEIGHT
Middle Name:
Last Name:WRIGHTMIRE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 W 6TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3635
Mailing Address - Country:US
Mailing Address - Phone:812-345-4318
Mailing Address - Fax:
Practice Address - Street 1:203 GOOD AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-7210
Practice Address - Country:US
Practice Address - Phone:812-345-4318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health