Provider Demographics
NPI:1457065641
Name:UPTON, BRYN (LGPC)
Entity Type:Individual
Prefix:
First Name:BRYN
Middle Name:
Last Name:UPTON
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 TOWN VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:MD
Mailing Address - Zip Code:21776-8713
Mailing Address - Country:US
Mailing Address - Phone:443-929-2289
Mailing Address - Fax:
Practice Address - Street 1:2845 TOWN VIEW CIR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:MD
Practice Address - Zip Code:21776-8713
Practice Address - Country:US
Practice Address - Phone:443-929-2289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health