Provider Demographics
NPI:1295456366
Name:RISING UP PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:RISING UP PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DEPETRO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:906-869-8003
Mailing Address - Street 1:2202 FITCH AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-1704
Mailing Address - Country:US
Mailing Address - Phone:906-869-8003
Mailing Address - Fax:
Practice Address - Street 1:112 W WASHINGTON ST STE D
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4367
Practice Address - Country:US
Practice Address - Phone:906-869-8003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health