Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | LP714 | KS |
Y | 103TC0700X | Clinical Psychologist | LP714 | KS |
N | 103TC1900X | Counseling Psychologist | LP714 | KS |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | LP714 | KS |
NPI | 1083766307 |
---|---|
Provider Name | Doug E Wright |
First Address | Iola, KS 66749-2327 |
Second Address | Chanute, KS 66720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 12/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
119690 | BLUE SHIELD (01) | KS |