Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PY0004349 | FL |
NPI | 1043221096 |
---|---|
Provider Name | Stephen Lance Wright |
First Address | Tallahassee, FL 32301-1250 |
Second Address | Tallahassee, FL 32301-1250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 15/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
73636 | BCBS (01) | FL |