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General NPI Number Information
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NPI Number | 1043886047
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Entity Type | Individual
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Provider Name | LAURIE ELIZABETH UPCHURCH MA
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Gender | Female
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 06/18/2022
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Provider Practice Location Address
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Address Line | 141 TOWNSHIP AVE STE 303
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City | RIDGELAND
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State | MS
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Zip | 39157-8699
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Country | US
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Telephone | 601-921-7522
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 678
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City | MADISON
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State | MS
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Zip | 39130-0678
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Country | US
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Telephone | 601-850-9300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2834
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License Number State | MS
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