Individual
MR. CHARLES TYLER UPTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISAC, PLC
Contact information
Practice address
721 N. FOURTH AVE, TUCSON, AZ 85705
(520) 202-1870
(520) 202-1889
Mailing address
1650 E. FORT LOWELL RD, STE 202, TUCSON, AZ 85719-2378
(520) 327-4505
(520) 202-1889
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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