Healthcare Provider Details

I. General information

NPI: 1982989778
Provider Name (Legal Business Name): SHELLY IRENE WRIGHT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 E MAIN ST
MURFREESBORO TN
37130-4043
US

IV. Provider business mailing address

5340 JOHNSON RD.
MURFREESBORO TN
37127
US

V. Phone/Fax

Practice location:
  • Phone: 615-896-7377
  • Fax:
Mailing address:
  • Phone: 615-848-3719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5320
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: