Provider Demographics
NPI:1780028027
Name:UNDERWOOD, SARA JEAN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 FORD PKWY # 5297
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2850
Mailing Address - Country:US
Mailing Address - Phone:651-243-6657
Mailing Address - Fax:
Practice Address - Street 1:2136 FORD PKWY # 5297
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-2850
Practice Address - Country:US
Practice Address - Phone:651-243-6657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202548106H00000X
MN2410106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist