Healthcare Provider Details

I. General information

NPI: 1477527752
Provider Name (Legal Business Name): LINDA R UPTON PH.D., M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 N OAK HILLS PKWY SUITE B
BATON ROUGE LA
70810-2859
US

IV. Provider business mailing address

10630 N OAK HILLS PKWY SUITE B
BATON ROUGE LA
70810-2859
US

V. Phone/Fax

Practice location:
  • Phone: 225-763-6300
  • Fax: 225-763-9358
Mailing address:
  • Phone: 225-763-6300
  • Fax: 225-763-9358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number608MP
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMPAP.000018
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMP.0608
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: