=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902786478
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UPLAND PSYCHOTHERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2025
-----------------------------------------------------
Last Update Date | 09/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1223 MACARTHUR AVE
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54806-3824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-544-7454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1223 MACARTHUR AVE
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54806-3824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-544-7454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | ROBIN JOANNE KEMKES
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 715-544-7454
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------