Provider Demographics
NPI:1467502625
Name:UNDERWOOD, JODI M (MA, LPC, LAC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:M
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MA, LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4957 BIG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-6739
Mailing Address - Country:US
Mailing Address - Phone:337-477-0708
Mailing Address - Fax:337-477-0508
Practice Address - Street 1:4957 BIG LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-6739
Practice Address - Country:US
Practice Address - Phone:337-477-0708
Practice Address - Fax:337-477-0508
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA743101YA0400X
LA3302101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)