Healthcare Provider Details

I. General information

NPI: 1093062580
Provider Name (Legal Business Name): DAVID L WRIGHT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 09/06/2023
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 BECKER
BELEN NM
87002
US

IV. Provider business mailing address

1894 CHAPARRAL LOOP
SOCORRO NM
87801
US

V. Phone/Fax

Practice location:
  • Phone: 575-517-0391
  • Fax: 575-517-0391
Mailing address:
  • Phone: 575-517-0391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID L WRIGHT
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW
Phone: 575-517-0391