Provider Demographics
NPI:1013268531
Name:UNDERWOOD, KERRY ANN (MS, LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:ANN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MS, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W. POPLAR STREET
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756
Mailing Address - Country:US
Mailing Address - Phone:479-986-8655
Mailing Address - Fax:479-633-9398
Practice Address - Street 1:409 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4560
Practice Address - Country:US
Practice Address - Phone:479-986-8655
Practice Address - Fax:479-633-9398
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1601004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty