Provider Demographics
NPI:1114157690
Name:UPTON, DANA (MS, MFT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:UPTON
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12516 HIGH BLUFF DRIVE, SUITE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130
Mailing Address - Country:US
Mailing Address - Phone:858-361-9349
Mailing Address - Fax:760-942-1984
Practice Address - Street 1:12526 HIGH BLUFF DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2064
Practice Address - Country:US
Practice Address - Phone:858-361-9349
Practice Address - Fax:760-942-1984
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41651106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist