Healthcare Provider Details

I. General information

NPI: 1962352211
Provider Name (Legal Business Name): UPSTREAM BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 GROVE HEIGHTS RD
BERKELEY SPRINGS WV
25411-5144
US

IV. Provider business mailing address

144 GROVE HEIGHTS RD
BERKELEY SPRINGS WV
25411-5144
US

V. Phone/Fax

Practice location:
  • Phone: 304-207-0515
  • Fax:
Mailing address:
  • Phone: 304-207-0515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY HENDERSHOT
Title or Position: OWNER/THERAPIST
Credential: LICSW
Phone: 304-207-0515