| Doctor Name: | MS. JACQUELYN L UPSHAW |
| NPI Number: | 1902005283 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN,LPC |
| License Number: | 1598 |
| Business Practice Address: | 4601 Corbett Dr Ft Collins, CO - 805289579 |
| Business Phone Number: | 9702074800 |
| Business Fax Number: | 9702074805 |
| Mailing Address: | 4601 Corbett Dr, FT COLLINS |
| State: | CO |
| Postal Code: | 805289579 |
| Phone Number: | 9702074800 |
| Fax Number: | 9702074805 |
| NPI Enumeration Date: | 07/16/2007 |
| NPI Last Update Date: | 07/16/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 1598 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |