Basic Information
| Provider Information | |||||||||
| NPI: | 1003292780 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UPTON | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MATTHEW | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4444 S 700 E STE 203 | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841073075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012684887 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4444 S 700 E STE 203 | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841073075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012684887 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2015 | ||||||||
| LastUpdateDate: | 05/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 7964844-3501 | UT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 103K00000X | 7964844-2506 | UT | N | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.