Healthcare Provider Details

I. General information

NPI: 1225300593
Provider Name (Legal Business Name): KELLY RICHWOOD WRIGHT M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1069 BROADWAY AVE STE 201
SEASIDE CA
93955-4995
US

IV. Provider business mailing address

1069 BROADWAY AVE STE 201
SEASIDE CA
93955-4995
US

V. Phone/Fax

Practice location:
  • Phone: 831-392-1500
  • Fax: 831-392-1501
Mailing address:
  • Phone: 831-392-1500
  • Fax: 831-392-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: