Provider Demographics
NPI:1669598363
Name:FORREST-WRIGHT, MARY (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:FORREST-WRIGHT
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 BLUE WATERLEAF LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-2319
Mailing Address - Country:US
Mailing Address - Phone:512-351-1153
Mailing Address - Fax:
Practice Address - Street 1:1501 HIGHWAY 290 W OFC 1340
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621
Practice Address - Country:US
Practice Address - Phone:512-351-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4816106H00000X
TX15319101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0959009-01Medicaid
TX260896161Medicare UPIN
TX562031000Medicare UPIN
TX0959009-01Medicaid
TX7567117Medicare UPIN