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General NPI Number Information
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NPI Number | 1639985732
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Entity Type | Organization
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Legal Business Name | UPSTART RESILIENCE
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 10310 WEST MARKHAM SUITE 222, UNIT 11
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City | LITTLE ROCK
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State | AR
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Zip | 72205-1579
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Country | US
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Telephone | 507-218-1125
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Fax |
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Provider Business Mailing Address
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Address Line | 610 6TH AVE SW
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City | AUSTIN
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State | MN
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Zip | 55912-2517
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Country | US
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Telephone | 507-696-2249
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | KRIS BERTELSEN
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Credential | PH.D., M.A.
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Telephone | 507-696-2249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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