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General NPI Number Information
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NPI Number | 1710473616
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Entity Type | Organization
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Legal Business Name | ROXANNE UPSHAW, INC.
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 441 MANITOU AVE STE 201
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City | MANITOU SPRINGS
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State | CO
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Zip | 80829-2334
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Country | US
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Telephone | 719-963-6487
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 622
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City | MANITOU SPRINGS
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State | CO
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Zip | 80829-0622
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROXANNE UPSHAW
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Credential | PHD, LPC
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Telephone | 719-963-6487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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