Organization
WRIGHT ENHANCEMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OTIS T JACKSON JR. (CEO/PRESIDENT)
(901) 207-4662
Entity
Organization
Contact information
Practice address
3311 KIMBALL AVE, MEMPHIS, TN 38111-3846
(901) 207-4662
Mailing address
3311 KIMBALL AVE, MEMPHIS, TN 38111-3846
(901) 207-4662
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
Primary
1000000015105
TN
103TC1900X
Counseling Psychologist
1000000015105
TN
103TP2701X
Group Psychotherapy Psychologist
1000000015105
TN
251S00000X
Community/Behavioral Health Agency
1000000015105
TN
Other
Enumeration date
11/14/2014
Last updated
11/14/2014
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