Provider Demographics
NPI:1043370141
Name:WRIGHT, JEFFREY D (MA, NCC, LPC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:D
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 12TH AVE RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5011
Mailing Address - Country:US
Mailing Address - Phone:208-250-4642
Mailing Address - Fax:208-466-5802
Practice Address - Street 1:112 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5051
Practice Address - Country:US
Practice Address - Phone:208-465-5433
Practice Address - Fax:208-466-5802
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3506101YM0800X
IDLCPC-4054101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010153421OtherBLUE SHIELD OF IDAHO
IDLCPC-4054OtherIDAHO LCPC LICENSURE NUMBER
IDLPC-3506OtherIDAHO LPC LICENSURE NBR
IDX6881OtherBLUE CROSS OF IDAHO