Healthcare Provider Details

I. General information

NPI: 1265947642
Provider Name (Legal Business Name): MICHAEL WRIGHT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 12/07/2017
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 Code103T00000X
TaxonomyPsychologist
License Number25432
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-18160
License Number StateNULL

VIII. Authorized Official

Name: DR. MICHAEL P WRIGHT
Title or Position: OWNER
Credential: PHD
Phone: 562-241-1603