Provider Demographics
NPI:1477527752
Name:UPTON, LINDA R (PHD, MP)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:R
Last Name:UPTON
Suffix:
Gender:F
Credentials:PHD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10630 N OAK HILLS PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2859
Mailing Address - Country:US
Mailing Address - Phone:225-763-6300
Mailing Address - Fax:225-763-9358
Practice Address - Street 1:10630 N OAK HILLS PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2859
Practice Address - Country:US
Practice Address - Phone:225-763-6300
Practice Address - Fax:225-763-9358
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA608MP103TC0700X
LAMPAP.000018103TP0016X
MP.0608103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S372Medicare ID - Type Unspecified