Provider Demographics
NPI:1629773809
Name:UNDERWOOD, KATIE (ATR, LMHC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:ATR, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 SAGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-0412
Mailing Address - Country:US
Mailing Address - Phone:404-281-5477
Mailing Address - Fax:
Practice Address - Street 1:4500 W SHANNON LAKES DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-2285
Practice Address - Country:US
Practice Address - Phone:404-281-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-210221700000X
FLMH22045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist