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General NPI Number Information
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NPI Number | 1023566999
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Entity Type | Organization
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Legal Business Name | UP-WARD ABA
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 2068 EVELYN AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-5416
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Country | US
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Telephone | 901-308-4762
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Fax | 901-234-0221
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Provider Business Mailing Address
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Address Line | 2068 EVELYN AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-5416
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Country | US
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Telephone | 901-308-4762
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Fax | 901-234-0221
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. BRANDEE LYNN MASTERSON
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Credential | MS, BCBA
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Telephone | 731-234-1873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1-14-17291
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License Number State | CO
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