Provider Demographics
NPI:1700130861
Name:WRIGHT, LACEY MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LACEY
Middle Name:MICHELLE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 S COOPER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3407
Mailing Address - Country:US
Mailing Address - Phone:682-777-4325
Mailing Address - Fax:
Practice Address - Street 1:3620 S COOPER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-3407
Practice Address - Country:US
Practice Address - Phone:682-777-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-28
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36255103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist