Healthcare Provider Details

I. General information

NPI: 1083139356
Provider Name (Legal Business Name): MARY ISABELLE WRIGHT MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W GREGORY BLVD
KANSAS CITY MO
64114-1140
US

IV. Provider business mailing address

2525 MAIN ST APT 207
KANSAS CITY MO
64108-2629
US

V. Phone/Fax

Practice location:
  • Phone: 816-361-0664
  • Fax: 816-361-0677
Mailing address:
  • Phone: 816-456-5330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2017023864
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: