Provider Demographics
NPI:1083743702
Name:WRIGHT, TANA J (LCSW)
Entity type:Individual
Prefix:
First Name:TANA
Middle Name:J
Last Name:WRIGHT
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1833
Mailing Address - Country:US
Mailing Address - Phone:502-365-0838
Mailing Address - Fax:502-371-0760
Practice Address - Street 1:774 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1833
Practice Address - Country:US
Practice Address - Phone:502-365-0838
Practice Address - Fax:502-371-0760
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5190104100000X
1041C0700X
KY34651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100161110Medicaid
KY7100161110Medicaid
KYK016612Medicare PIN
KYK016610Medicare PIN
KYK016614Medicare PIN
KYK016613Medicare PIN
KYK016615Medicare PIN