MEDICARE: JUSTIN TAYLOR 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1932848827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN TAYLOR WRIGHT

Provider Business Mailing Address
First Line	:	1508 NW VIVION RD STE 319
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-4557
Country	:	US
Telephone Number	:	816-699-2047
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 NW VIVION RD STE 319
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-4557
Country	:	US
Telephone Number	:	816-699-2047
Fax Number	:

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

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	11/30/2022

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