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General NPI Number Information
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NPI Number | 1093062580
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Entity Type | Organization
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Legal Business Name | DAVID L WRIGHT
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 614 BECKER
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City | BELEN
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State | NM
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Zip | 87002
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Country | US
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Telephone | 575-517-0391
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Fax | 575-517-0391
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Provider Business Mailing Address
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Address Line | 1894 CHAPARRAL LOOP
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City | SOCORRO
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State | NM
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Zip | 87801
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Country | US
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Telephone | 575-517-0391
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DAVID L WRIGHT
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Credential | LMSW
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Telephone | 575-517-0391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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