Healthcare Provider Details

I. General information

NPI: 1497162044
Provider Name (Legal Business Name): MICAH B WRIGHT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35TH MDG UNIT 5024
APO AP
96319-5024
US

IV. Provider business mailing address

35TH MDG UNIT 5024
APO AP
96319-5024
US

V. Phone/Fax

Practice location:
  • Phone: 315-226-3230
  • Fax:
Mailing address:
  • Phone: 315-226-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number51851
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: