Provider Demographics
NPI:1104501501
Name:WRIGHT, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2581 WILLAKENZIE RD APT 6
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4812
Mailing Address - Country:US
Mailing Address - Phone:805-315-1127
Mailing Address - Fax:
Practice Address - Street 1:2581 WILLAKENZIE RD APT 6
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4812
Practice Address - Country:US
Practice Address - Phone:805-315-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7937101YM0800X
ORT2816106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health