Healthcare Provider Details

I. General information

NPI: 1144439662
Provider Name (Legal Business Name): HANNAH K. UPHAM MA,LPC,ATR, HTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E. SIMPSON ST. UNIT G2
LAFAYETTE CO
80026
US

IV. Provider business mailing address

916 CLOVER CIR.
LAFAYETTE CO
80026
US

V. Phone/Fax

Practice location:
  • Phone: 303-709-4912
  • Fax:
Mailing address:
  • Phone: 303-709-4912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC#5567
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC#5567
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC#5567
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberATR#08-036
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: