Provider Demographics
NPI:1912335514
Name:WRIGHT, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 WOODLAND CIR
Mailing Address - Street 2:APT #102
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-2004
Mailing Address - Country:US
Mailing Address - Phone:772-770-4932
Mailing Address - Fax:
Practice Address - Street 1:1820 WOODLAND CIR
Practice Address - Street 2:APT #102
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-2004
Practice Address - Country:US
Practice Address - Phone:772-770-4932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health