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General NPI Number Information
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NPI Number | 1295456366
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Entity Type | Organization
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Legal Business Name | RISING UP PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 112 W WASHINGTON ST STE D
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City | MARQUETTE
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State | MI
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Zip | 49855-4367
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Country | US
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Telephone | 906-869-8003
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Fax |
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Provider Business Mailing Address
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Address Line | 2202 FITCH AVE
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City | MARQUETTE
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State | MI
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Zip | 49855-1704
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Country | US
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Telephone | 906-869-8003
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. EMILY ELIZABETH DEPETRO
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Credential | PSYD
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Telephone | 906-869-8003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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