Provider Demographics
NPI:1053931535
Name:UPSHAW, KIESHA (RBT)
Entity type:Individual
Prefix:
First Name:KIESHA
Middle Name:
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20502 PROVIDENCE POINT DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-2054
Mailing Address - Country:US
Mailing Address - Phone:203-249-9137
Mailing Address - Fax:
Practice Address - Street 1:20502 PROVIDENCE POINT DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-2054
Practice Address - Country:US
Practice Address - Phone:203-249-9137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst