Provider Demographics
NPI:1619557642
Name:UPSTATE BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:UPSTATE BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIMZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-323-7427
Mailing Address - Street 1:488 CATFISH CV
Mailing Address - Street 2:
Mailing Address - City:CHAPPELLS
Mailing Address - State:SC
Mailing Address - Zip Code:29037-8950
Mailing Address - Country:US
Mailing Address - Phone:864-323-7427
Mailing Address - Fax:
Practice Address - Street 1:488 CATFISH CV
Practice Address - Street 2:
Practice Address - City:CHAPPELLS
Practice Address - State:SC
Practice Address - Zip Code:29037-8950
Practice Address - Country:US
Practice Address - Phone:864-323-7427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPG1037Medicaid