Provider Demographics
NPI:1083311906
Name:UPREACH, INC
Entity Type:Organization
Organization Name:UPREACH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOUZON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-558-2055
Mailing Address - Street 1:PO BOX 91250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30364-1250
Mailing Address - Country:US
Mailing Address - Phone:404-558-2055
Mailing Address - Fax:470-237-2396
Practice Address - Street 1:2950 MOUNT WILKINSON PKWY SE UNIT 1001
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3681
Practice Address - Country:US
Practice Address - Phone:404-558-2055
Practice Address - Fax:470-237-2396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health