Provider Demographics
NPI:1740633122
Name:UPP, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:UPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 CHELSEA LN
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-5128
Mailing Address - Country:US
Mailing Address - Phone:813-787-2998
Mailing Address - Fax:
Practice Address - Street 1:10425 SOARING EAGLE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3354
Practice Address - Country:US
Practice Address - Phone:813-236-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor