Provider Demographics
NPI:1639651508
Name:ROBERT UPDEGROVE COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:ROBERT UPDEGROVE COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:UPDEGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-473-3976
Mailing Address - Street 1:197 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BCH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2160
Mailing Address - Country:US
Mailing Address - Phone:407-473-3976
Mailing Address - Fax:
Practice Address - Street 1:1800 PENN ST STE 12
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2625
Practice Address - Country:US
Practice Address - Phone:407-473-3976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014949200Medicaid
1720213200OtherNPI