Provider Demographics
NPI:1407182272
Name:UNDERWOOD, SANDRA M (MS, LPC, LAMFT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:M
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MS, LPC, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N WALTON BLVD
Mailing Address - Street 2:SUITE M
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4546
Mailing Address - Country:US
Mailing Address - Phone:479-270-2806
Mailing Address - Fax:870-455-4485
Practice Address - Street 1:615 N WALTON BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4546
Practice Address - Country:US
Practice Address - Phone:479-270-2806
Practice Address - Fax:870-455-4485
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1204003106H00000X
ARP1701231101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist