Provider Demographics
NPI:1497321053
Name:UNDERWOOD THERAPY PLLC
Entity Type:Organization
Organization Name:UNDERWOOD THERAPY PLLC
Other - Org Name:UNDERWOOD THERAPY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:931-219-9320
Mailing Address - Street 1:1030 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1852
Mailing Address - Country:US
Mailing Address - Phone:931-219-9320
Mailing Address - Fax:
Practice Address - Street 1:320 E BROAD ST FL 2
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3382
Practice Address - Country:US
Practice Address - Phone:931-219-9320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ066566Medicaid