Provider Demographics
NPI:1134919095
Name:WRIGHT, NICKLAS
Entity type:Individual
Prefix:
First Name:NICKLAS
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 BEAVER VU DR STE C
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6368
Mailing Address - Country:US
Mailing Address - Phone:937-306-8077
Mailing Address - Fax:
Practice Address - Street 1:3171 BEAVER VU DR STE C
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6368
Practice Address - Country:US
Practice Address - Phone:937-306-8077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor