Healthcare Provider Details

I. General information

NPI: 1851027684
Provider Name (Legal Business Name): TERESA MARIE WRIGHT QMHP, QIDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 10TH AVE
MENOMINEE MI
49858-3009
US

IV. Provider business mailing address

401 10TH AVE
MENOMINEE MI
49858-3009
US

V. Phone/Fax

Practice location:
  • Phone: 906-863-7841
  • Fax: 906-863-2833
Mailing address:
  • Phone: 906-863-7841
  • Fax: 906-863-2833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6803087256
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: