Provider Demographics
NPI:1457525404
Name:UPTON, LISA M (MED AAC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:UPTON
Suffix:
Gender:F
Credentials:MED AAC
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:YEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA RC
Mailing Address - Street 1:8815 S TACOMA WAY
Mailing Address - Street 2:SUITE 122
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4587
Mailing Address - Country:US
Mailing Address - Phone:253-682-0353
Mailing Address - Fax:253-682-0301
Practice Address - Street 1:5301 TIETON DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3478
Practice Address - Country:US
Practice Address - Phone:509-965-7100
Practice Address - Fax:509-966-9750
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00060345101YM0800X
WA1457525404103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health