Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 7964844-2506 | UT |
Y | 1041C0700X | Clinical Social Worker | 7964844-3501 | UT |
NPI | 1003292780 |
---|---|
Provider Name | Mr. James Matthew Upton |
First Address | Murray, UT 84107-3075 |
Second Address | Murray, UT 84107-3075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2015 |
Last Update Date | 20/05/2019 |