Healthcare Provider Details

I. General information

NPI: 1992982219
Provider Name (Legal Business Name): STEPHEN L WRIGHT PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 CHERRY LAUREL ST
TALLAHASSEE FL
32308-5104
US

IV. Provider business mailing address

1320 CHERRY LAUREL ST
TALLAHASSEE FL
32308-5104
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-5655
  • Fax: 850-877-5610
Mailing address:
  • Phone: 850-877-5655
  • Fax: 850-877-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0004349
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number873002
License Number StateFL

VIII. Authorized Official

Name: DR. STEPHEN L WRIGHT
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 850-877-5655