Provider Demographics
NPI:1669864096
Name:UNDERWOOD, LUANN (LMSW, ICADC, CSAC)
Entity Type:Individual
Prefix:MRS
First Name:LUANN
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:LMSW, ICADC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7424 APENNINES DRIVE
Mailing Address - Street 2:ARMY SUBSTANCE ABUSE PROGRAM
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442
Mailing Address - Country:US
Mailing Address - Phone:785-240-6573
Mailing Address - Fax:785-239-0631
Practice Address - Street 1:7424 APENNINES DRIVE
Practice Address - Street 2:ARMY SUBSTANCE ABUSE PROGRAM
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442
Practice Address - Country:US
Practice Address - Phone:785-240-6573
Practice Address - Fax:785-239-0631
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1826-14101YA0400X
KS9278104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)