MEDICARE: MICHAEL WRIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-15-18160
2	103T00000X	Psychologist	25432	CA

General Provider Information

NPI Number	:	1265947642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL WRIGHT

Provider Business Mailing Address
First Line	:	6714 E DRISCOLL ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4849
Country	:	US
Telephone Number	:	562-241-1603
Fax Number	:

Provider Business Practice Location Address
First Line	:	6714 E DRISCOLL ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4849
Country	:	US
Telephone Number	:	562-241-1603
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL P WRIGHT
Credential	:	PHD
Telephone Number	:	562-241-1603

Provider Enumeration Date	:	12/07/2017
Last Update Date	:	12/07/2017

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Directions to “MICHAEL WRIGHT ” Practice Location

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