MEDICARE: DR. MICHAEL PHILIP WRIGHT P.H.D.

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	103K00000X	Behavior Analyst	1-15-18160
2	103TC2200X	Clinical Child & Adolescent Psychologist	25432	CA
3	103TC0700X	Clinical Psychologist	PSY24532	CA

General Provider Information

NPI Number	:	1669678835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL PHILIP WRIGHT P.H.D.

Provider Business Mailing Address
First Line	:	6714 E DRISCOLL ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4849
Country	:	US
Telephone Number	:	562-241-1603
Fax Number	:

Provider Business Practice Location Address
First Line	:	6714 E DRISCOLL ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4849
Country	:	US
Telephone Number	:	562-241-1603
Fax Number	:

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	03/17/2018

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