Healthcare Provider Details

I. General information

NPI: 1174254635
Provider Name (Legal Business Name): CHRISTOPHER WRIGHT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3553 E JORDAN DR
POST FALLS ID
83854-5375
US

IV. Provider business mailing address

3553 E JORDAN DR
POST FALLS ID
83854-5375
US

V. Phone/Fax

Practice location:
  • Phone: 208-818-4298
  • Fax:
Mailing address:
  • Phone: 208-818-4298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3956
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: