Provider Demographics
NPI:1265196620
Name:JESSICA K. WRIGHT, LCMHC
Entity type:Organization
Organization Name:JESSICA K. WRIGHT, LCMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:802-505-8596
Mailing Address - Street 1:3488 THAYER BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:VT
Mailing Address - Zip Code:05060-9201
Mailing Address - Country:US
Mailing Address - Phone:802-505-8596
Mailing Address - Fax:
Practice Address - Street 1:28 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1265
Practice Address - Country:US
Practice Address - Phone:802-505-8596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty