Provider Demographics
NPI:1225787005
Name:UPSTATE MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:UPSTATE MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:864-365-2729
Mailing Address - Street 1:104 N DANIEL MORGAN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-2363
Mailing Address - Country:US
Mailing Address - Phone:864-365-2729
Mailing Address - Fax:864-383-5093
Practice Address - Street 1:104 N DANIEL MORGAN AVE STE 105
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-2363
Practice Address - Country:US
Practice Address - Phone:864-365-2729
Practice Address - Fax:864-383-5093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health