Provider Demographics
NPI:1366887804
Name:WRIGHT, RAE (LCSW, LCDC)
Entity type:Individual
Prefix:
First Name:RAE
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 RIVERSIDE TRL
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5924
Mailing Address - Country:US
Mailing Address - Phone:254-933-9400
Mailing Address - Fax:
Practice Address - Street 1:3804 RIVERSIDE TRL
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5924
Practice Address - Country:US
Practice Address - Phone:254-933-9400
Practice Address - Fax:254-933-7861
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
TX530861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)