Provider Demographics
NPI:1528571940
Name:UPWELL, JUSTIN ROSS (MA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ROSS
Last Name:UPWELL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:JUSTIN
Other - Middle Name:ROSS
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4242 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-2618
Mailing Address - Country:US
Mailing Address - Phone:720-382-5900
Mailing Address - Fax:303-825-8166
Practice Address - Street 1:301 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-5182
Practice Address - Country:US
Practice Address - Phone:303-602-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0016219101YP2500X
COACD.0001282101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)