Provider Demographics
NPI:1770781866
Name:THEBERT-WRIGHT, COLLEEN ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:ANN
Last Name:THEBERT-WRIGHT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 W MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-3730
Mailing Address - Country:US
Mailing Address - Phone:269-567-4167
Mailing Address - Fax:269-567-2497
Practice Address - Street 1:4031 W MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-3730
Practice Address - Country:US
Practice Address - Phone:269-567-4167
Practice Address - Fax:269-567-2497
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012124103G00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist