MEDICARE: CONSTANCE WRIGHT EDS, LPC-A

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	101YP2500X	Professional Counselor	90537	SC
2	101YS0200X	School Counselor	271535	SC
3	101Y00000X	Counselor	90537	TX

General Provider Information

NPI Number	:	1649975343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE WRIGHT EDS, LPC-A

Provider Business Mailing Address
First Line	:	5735 GASTON AVE APT 107
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-6449
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5735 GASTON AVE APT 107
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-6449
Country	:	US
Telephone Number	:	469-949-3314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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