=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316632490
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY JANE WRIGHT LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2023
-----------------------------------------------------
Last Update Date | 04/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 531 E 5TH ST
-----------------------------------------------------
City | BURLEY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83318-1469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-678-3555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1110
-----------------------------------------------------
City | GLENNS FERRY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83623-1110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-670-4339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | LPC-9285
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------