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General NPI Number Information
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NPI Number | 1194944173
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Entity Type | Individual
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Provider Name | ANDREW SPENCER UPHAM MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9501 W COYOTE HILL RD
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City | HARRISBURG
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State | MO
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Zip | 65256-9598
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Country | US
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Telephone | 573-874-0179
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 N BOOTHE LN
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City | COLUMBIA
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State | MO
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Zip | 65202-9516
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Country | US
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Telephone | 573-881-3711
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2001033192
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License Number State | MO
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