Healthcare Provider Details

I. General information

NPI: 1033689427
Provider Name (Legal Business Name): JULIA WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 LAKELAND DR STE P121
JACKSON MS
39216-4943
US

IV. Provider business mailing address

1516 DEVINE ST
JACKSON MS
39202-1311
US

V. Phone/Fax

Practice location:
  • Phone: 601-954-3964
  • Fax:
Mailing address:
  • Phone: 601-954-3964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: