Provider Demographics
NPI:1770298770
Name:WRIGHT, SHATOURIA MCCLELLAN
Entity type:Individual
Prefix:MRS
First Name:SHATOURIA
Middle Name:MCCLELLAN
Last Name:WRIGHT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHATOURIA
Other - Middle Name:K
Other - Last Name:MCCLELLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3394
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056-3394
Mailing Address - Country:US
Mailing Address - Phone:386-292-2958
Mailing Address - Fax:386-406-8340
Practice Address - Street 1:260 S MARION AVE STE 135
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-7000
Practice Address - Country:US
Practice Address - Phone:386-697-8842
Practice Address - Fax:386-406-8340
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty