Healthcare Provider Details

I. General information

NPI: 1871299354
Provider Name (Legal Business Name): CALYPSO TELEPSYCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10990 BLACKTAIL LOOP
PENSACOLA FL
32526-4578
US

IV. Provider business mailing address

10990 BLACKTAIL LOOP
PENSACOLA FL
32526-4578
US

V. Phone/Fax

Practice location:
  • Phone: 618-559-7363
  • Fax:
Mailing address:
  • Phone: 618-559-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LEIGH UPCRAFT
Title or Position: OWNER/MANAGER
Credential: PMHNP
Phone: 618-559-7363