Healthcare Provider Details

I. General information

NPI: 1174030761
Provider Name (Legal Business Name): TIMOTHY ALLEN WRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 S CENTRAL ST
VISALIA CA
93277-4418
US

IV. Provider business mailing address

1830 S CENTRAL ST
VISALIA CA
93277-4418
US

V. Phone/Fax

Practice location:
  • Phone: 559-730-2969
  • Fax: 559-730-2991
Mailing address:
  • Phone: 559-730-2969
  • Fax: 559-730-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: