Provider Demographics
NPI:1336445436
Name:WRIGHT, RANDI MICHELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:MICHELLE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RANDI
Other - Middle Name:MICHELLE
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1987
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-1987
Mailing Address - Country:US
Mailing Address - Phone:972-515-0834
Mailing Address - Fax:972-564-4564
Practice Address - Street 1:300 E BROAD ST
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-9164
Practice Address - Country:US
Practice Address - Phone:972-515-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52553104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker