Provider Demographics
NPI:1043379498
Name:KAREN K UNDERWOOD PHD LLC
Entity Type:Organization
Organization Name:KAREN K UNDERWOOD PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-338-7228
Mailing Address - Street 1:2815 N CHELTON RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1009
Mailing Address - Country:US
Mailing Address - Phone:719-474-7425
Mailing Address - Fax:719-630-1997
Practice Address - Street 1:2815 N CHELTON RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1009
Practice Address - Country:US
Practice Address - Phone:719-338-7228
Practice Address - Fax:719-630-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1820273Y00000X, 3104A0625X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No273Y00000XHospital UnitsRehabilitation Unit
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07182025Medicaid
CO07182025Medicaid