Provider Demographics
NPI:1730760562
Name:UPWARD ABA
Entity type:Organization
Organization Name:UPWARD ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:731-234-1873
Mailing Address - Street 1:6858 SWINNEA RD BLDG 6B
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9493
Mailing Address - Country:US
Mailing Address - Phone:662-426-6136
Mailing Address - Fax:662-499-6136
Practice Address - Street 1:6858 SWINNEA RD BLDG 6B
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9493
Practice Address - Country:US
Practice Address - Phone:662-426-6136
Practice Address - Fax:662-499-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1811467731OtherNPI
TN1962751933Medicaid