MEDICARE: KAITLYN RACHEL WRIGHT LPC

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	101YP2500X	Professional Counselor	6401223541	MI

General Provider Information

NPI Number	:	1053964643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN RACHEL WRIGHT LPC

Provider Business Mailing Address
First Line	:	14734 160TH AVE
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-8971
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14734 160TH AVE
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-8971
Country	:	US
Telephone Number	:	501-322-1774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	12/14/2025

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