Healthcare Provider Details

I. General information

NPI: 1205578317
Provider Name (Legal Business Name): JACI WRIGHT LMHC, LIMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23378 SW 57TH AVE APT 202
BOCA RATON FL
33428-7706
US

IV. Provider business mailing address

23378 SW 57TH AVE APT 202
BOCA RATON FL
33428-7706
US

V. Phone/Fax

Practice location:
  • Phone: 308-340-7609
  • Fax:
Mailing address:
  • Phone: 308-340-7609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2691
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: