Organization
UP-WARD ABA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRANDEE LYNN MASTERSON MS, BCBA (EXECUTIVE DIRECTOR)
(731) 234-1873
Entity
Organization
Contact information
Practice address
2068 EVELYN AVE, MEMPHIS, TN 38104-5416
(901) 308-4762
(901) 234-0221
Mailing address
2068 EVELYN AVE, MEMPHIS, TN 38104-5416
(901) 308-4762
(901) 234-0221
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1-14-17291
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811467731
—
TN
05
—
Q019056
—
TN
Enumeration date
09/20/2016
Last updated
04/14/2021
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