Individual
GORDON RAY WRIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW LCSW
Contact information
Practice address
750 N 200 W, PROVO, UT 84601
(801) 373-4760
(801) 373-0639
Mailing address
750 N 200 W, PROVO, UT 84601
(801) 373-4760
(801) 373-0639
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1368853501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005742634
MEDICARE ID TYPE UNSPECIFIED
UT
05
—
005742634
—
UT
Enumeration date
09/01/2006
Last updated
04/15/2014
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