Provider Demographics
NPI:1043009517
Name:WRIGHT, KEVIN ANTHONY (EDS, PHD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ANTHONY
Last Name:WRIGHT
Suffix:
Gender:
Credentials:EDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7046 W CANDLEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-6972
Mailing Address - Country:US
Mailing Address - Phone:310-754-5362
Mailing Address - Fax:
Practice Address - Street 1:7046 W CANDLEWOOD WAY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-6972
Practice Address - Country:US
Practice Address - Phone:310-754-5362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4506584103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist