MEDICARE: COLLEEN H WRIGHT LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1023462710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLEEN H WRIGHT LMHC

Provider Business Mailing Address
First Line	:	10752 DEERWOOD PARK BLVD
Second Line	:	SUITE 100
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4849
Country	:	US
Telephone Number	:	904-394-2868
Fax Number	:

Provider Business Practice Location Address
First Line	:	10752 DEERWOOD PARK BLVD
Second Line	:	SUITE 100
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4849
Country	:	US
Telephone Number	:	904-394-2868
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. COLLEEN HILL WRIGHT
Credential	:	LMHC
Telephone Number	:	904-394-2868

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	04/19/2016

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