Provider Demographics
NPI:1831890037
Name:UPCHURCH, BECKY SUE (LAC)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:SUE
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 WILLIAM D TATE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-4326
Mailing Address - Country:US
Mailing Address - Phone:817-210-6694
Mailing Address - Fax:
Practice Address - Street 1:2800 WILLIAM D TATE AVE STE 300
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-4326
Practice Address - Country:US
Practice Address - Phone:817-210-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC02102171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist