Provider Demographics
NPI:1205207750
Name:UNDERWOOD, RHONDA LYNN (MA, NCC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:LYNN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MA, NCC, LMHC
Other - Prefix:MISS
Other - First Name:RHONDA
Other - Middle Name:LYNN
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, NCC, LMHCA
Mailing Address - Street 1:517 FRANKLIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3328
Mailing Address - Country:US
Mailing Address - Phone:219-545-2972
Mailing Address - Fax:219-728-1485
Practice Address - Street 1:517 FRANKLIN ST # 104
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3328
Practice Address - Country:US
Practice Address - Phone:219-545-2972
Practice Address - Fax:219-728-1485
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000038A101YM0800X
IN39002765A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health