Provider Demographics
NPI:1679710669
Name:UNDERHILL, JOSEPHINE H (MED,LMHC)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:H
Last Name:UNDERHILL
Suffix:
Gender:F
Credentials:MED,LMHC
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:UNDERHILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:211 E RICH AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-4356
Mailing Address - Country:US
Mailing Address - Phone:386-747-7148
Mailing Address - Fax:
Practice Address - Street 1:211 E RICH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-4356
Practice Address - Country:US
Practice Address - Phone:386-747-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH9166OtherFLORIDA MENTAL HEALTH COUNSELOR LICENSE