Provider Demographics
NPI: | 1265322283 |
---|---|
Name: | UPSIDE BEHAVIORAL HEALTH |
Entity type: | Organization |
Organization Name: | UPSIDE BEHAVIORAL HEALTH |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOSHUA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BRODY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPC, |
Authorized Official - Phone: | 480-669-7471 |
Mailing Address - Street 1: | 7629 E BARSTOW ST |
Mailing Address - Street 2: | |
Mailing Address - City: | MESA |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85207-7522 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-669-7471 |
Mailing Address - Fax: | 480-914-9188 |
Practice Address - Street 1: | 7629 E BARSTOW ST |
Practice Address - Street 2: | |
Practice Address - City: | MESA |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85207-7522 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-669-7471 |
Practice Address - Fax: | 480-914-9188 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2025-07-09 |
Last Update Date: | 2025-07-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |