Healthcare Provider Details

I. General information

NPI: 1669678835
Provider Name (Legal Business Name): MICHAEL PHILIP WRIGHT P.H.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6714 E DRISCOLL ST
LONG BEACH CA
90815-4849
US

IV. Provider business mailing address

6714 E DRISCOLL ST
LONG BEACH CA
90815-4849
US

V. Phone/Fax

Practice location:
  • Phone: 562-241-1603
  • Fax:
Mailing address:
  • Phone: 562-241-1603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY24532
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number25432
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-18160
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: