Provider Demographics
NPI:1487242517
Name:WRIGHT, LEWIS N (LCDC)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:N
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-3393
Mailing Address - Country:US
Mailing Address - Phone:132-527-7879
Mailing Address - Fax:
Practice Address - Street 1:204 CHARLES DR
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-3393
Practice Address - Country:US
Practice Address - Phone:132-527-7879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X, 172A00000X
TX12643101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver