Provider Demographics
NPI:1023566999
Name:UP-WARD ABA
Entity Type:Organization
Organization Name:UP-WARD ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDEE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:731-234-1873
Mailing Address - Street 1:2068 EVELYN AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5416
Mailing Address - Country:US
Mailing Address - Phone:901-308-4762
Mailing Address - Fax:901-234-0221
Practice Address - Street 1:2068 EVELYN AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5416
Practice Address - Country:US
Practice Address - Phone:901-308-4762
Practice Address - Fax:901-234-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-14-17291251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ019056Medicaid
TN1811467731Medicaid