Provider Demographics
NPI:1497881304
Name:UNDERWOOD, AMANDA OWEN (MA, LPC-S)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:OWEN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MA, LPC-S
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3615 FOXBORO LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2937
Mailing Address - Country:US
Mailing Address - Phone:469-767-6888
Mailing Address - Fax:972-848-9777
Practice Address - Street 1:6010 W SPRING CREEK PKWY STE 232
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3569
Practice Address - Country:US
Practice Address - Phone:469-767-6888
Practice Address - Fax:972-848-9777
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19882101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306304134OtherNPI2 FOR AMANDA OWEN COUNSELING SERVICES PLLC