Provider Demographics
NPI:1639985732
Name:UPSTART RESILIENCE
Entity type:Organization
Organization Name:UPSTART RESILIENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MA
Authorized Official - Phone:507-696-2249
Mailing Address - Street 1:610 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2517
Mailing Address - Country:US
Mailing Address - Phone:507-696-2249
Mailing Address - Fax:
Practice Address - Street 1:10310 WEST MARKHAM
Practice Address - Street 2:SUITE 222, UNIT 11
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1579
Practice Address - Country:US
Practice Address - Phone:507-218-1125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty