Provider Demographics
NPI:1346237633
Name:UPCHURCH, JANET LYNN (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:LYNN
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:LYNN
Other - Last Name:MAFFEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2020 E GRAND AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4380
Mailing Address - Country:US
Mailing Address - Phone:208-490-0635
Mailing Address - Fax:
Practice Address - Street 1:2020 E GRAND AVE STE 410
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4380
Practice Address - Country:US
Practice Address - Phone:208-490-0635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-01
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-691101YP2500X
WY691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY2CF879B33DMedicaid