Provider Demographics
NPI:1982343760
Name:WRIGHT, AUSTIN CODY
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:CODY
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 RIGHT FORK OF LYKINS CRK
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-5627
Mailing Address - Country:US
Mailing Address - Phone:859-533-0784
Mailing Address - Fax:
Practice Address - Street 1:2335 E STATE AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8808
Practice Address - Country:US
Practice Address - Phone:844-249-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID43543104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker