=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942702808
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WRIGHT PROFESSIONAL COUNSELING, PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2018
-----------------------------------------------------
Last Update Date | 08/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2820 W MAPLE RD STE 131
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48084-7047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-909-1350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26313 WINTON ST
-----------------------------------------------------
City | SAINT CLAIR SHORES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48081-3883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-909-1350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | TAMI WRIGHT
-----------------------------------------------------
Credential | PH.D., LPC, SCL
-----------------------------------------------------
Telephone | 586-909-1350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------