Provider Demographics
NPI:1114221611
Name:WRIGHT, MIMI H (PHD, LP, LSSP)
Entity type:Individual
Prefix:DR
First Name:MIMI
Middle Name:H
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PHD, LP, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 COUNTY ROAD 4145
Mailing Address - Street 2:
Mailing Address - City:CRANFILLS GAP
Mailing Address - State:TX
Mailing Address - Zip Code:76637-4550
Mailing Address - Country:US
Mailing Address - Phone:254-253-0460
Mailing Address - Fax:
Practice Address - Street 1:201 POSEY AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76634-1200
Practice Address - Country:US
Practice Address - Phone:254-675-8621
Practice Address - Fax:254-675-2254
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25128103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030182203Medicaid