Provider Demographics
NPI:1821463670
Name:UNDERWOOD, AMANDA MICHELLE (LMFT, MS-MFT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:LMFT, MS-MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E BROAD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3382
Mailing Address - Country:US
Mailing Address - Phone:931-219-9320
Mailing Address - Fax:
Practice Address - Street 1:320 E BROAD ST FL 2
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3382
Practice Address - Country:US
Practice Address - Phone:931-219-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1865106H00000X, 106H00000X
WALF61111722106H00000X
WAMG60695632106H00000X
OKUNDER SUPERVISION106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist