Provider Demographics
NPI:1952702953
Name:UPSHAW, REBECCA (LMSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:UPSHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1110 J C ST,
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5217
Mailing Address - Country:US
Mailing Address - Phone:620-276-4482
Mailing Address - Fax:620-276-4485
Practice Address - Street 1:1110 J C ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6345
Practice Address - Country:US
Practice Address - Phone:620-276-4482
Practice Address - Fax:620-276-4485
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS92881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical