Provider Demographics
NPI:1801191556
Name:UPCHURCH, LORRAN ASHLY (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:LORRAN
Middle Name:ASHLY
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 MONROE ST STE 106A
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2797
Mailing Address - Country:US
Mailing Address - Phone:734-347-0606
Mailing Address - Fax:
Practice Address - Street 1:5600 MONROE ST STE 106A
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2797
Practice Address - Country:US
Practice Address - Phone:734-347-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0900584104100000X
OHI.12005571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0228790Medicaid