Healthcare Provider Details

I. General information

NPI: 1003750738
Provider Name (Legal Business Name): JUSITN HERNANDEZ WRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24500 CENTER RIDGE RD STE 110
WESTLAKE OH
44145-5604
US

IV. Provider business mailing address

5514 ARCHMERE AVE
CLEVELAND OH
44144-4015
US

V. Phone/Fax

Practice location:
  • Phone: 440-787-6311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2607939
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: