Provider Demographics
NPI:1811105216
Name:WRIGHT, JEREMIAH M (MA, LMFT)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:M
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E JEFFERSON BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1995
Mailing Address - Country:US
Mailing Address - Phone:574-383-5859
Mailing Address - Fax:855-387-0446
Practice Address - Street 1:105 E JEFFERSON BLVD STE 310
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1995
Practice Address - Country:US
Practice Address - Phone:574-383-5859
Practice Address - Fax:855-387-0446
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001570A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist