Provider Demographics
NPI:1528261799
Name:WRIGHT, JULIET RENE (MS,LCPC)
Entity type:Individual
Prefix:MRS
First Name:JULIET
Middle Name:RENE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MS,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 E BAKER ST
Mailing Address - Street 2:200 W. MONROE SUITE 306
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-6852
Mailing Address - Country:US
Mailing Address - Phone:309-829-6163
Mailing Address - Fax:
Practice Address - Street 1:200 W MONROE ST
Practice Address - Street 2:SUITE 306
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3997
Practice Address - Country:US
Practice Address - Phone:309-829-6163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.0006389101Y00000X
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered251S00000XAgenciesCommunity/Behavioral Health