Healthcare Provider Details

I. General information

NPI: 1841696101
Provider Name (Legal Business Name): WRIGHT ENHANCEMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 KIMBALL AVE
MEMPHIS TN
38111-3846
US

IV. Provider business mailing address

3311 KIMBALL AVE
MEMPHIS TN
38111-3846
US

V. Phone/Fax

Practice location:
  • Phone: 901-207-4662
  • Fax:
Mailing address:
  • Phone: 901-207-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1000000015105
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1000000015105
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1000000015105
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number1000000015105
License Number StateTN

VIII. Authorized Official

Name: OTIS T JACKSON JR.
Title or Position: CEO/PRESIDENT
Credential:
Phone: 901-207-4662