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Individual

MR. CHARLES TYLER UPTON

Active
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Individual

MR. CHARLES TYLER UPTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LISAC, PLC

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC10856
AZ
101YP2500X
Professional Counselor
LPC11260
AZ

Other

Enumeration date
10/19/2010
Last updated
10/19/2010
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