Provider Demographics
NPI:1417168683
Name:UNDERWOOD, GIOVANNA VINCENZA (CRC)
Entity Type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:VINCENZA
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 W MAYFLOWER WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3134
Mailing Address - Country:US
Mailing Address - Phone:801-331-6775
Mailing Address - Fax:801-766-2010
Practice Address - Street 1:3375 W MAYFLOWER WAY
Practice Address - Street 2:SUITE A
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-3134
Practice Address - Country:US
Practice Address - Phone:801-331-6775
Practice Address - Fax:801-766-2010
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9000386-6004106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist