Provider Demographics
NPI:1598897407
Name:UPCHURCH, CRYSTAL ROSE (BA)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:ROSE
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:1922 BROCKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744
Mailing Address - Country:US
Mailing Address - Phone:720-818-6448
Mailing Address - Fax:
Practice Address - Street 1:2859 S BUMBY AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-8704
Practice Address - Country:US
Practice Address - Phone:407-800-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-240235106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician