Provider Demographics
NPI:1770906885
Name:UNDERHILL, JASON SCOTT (BSW, ICADC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:SCOTT
Last Name:UNDERHILL
Suffix:
Gender:M
Credentials:BSW, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E BRECKINRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203
Mailing Address - Country:US
Mailing Address - Phone:812-653-1908
Mailing Address - Fax:502-371-0829
Practice Address - Street 1:214 E BRECKINRIDGE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203
Practice Address - Country:US
Practice Address - Phone:812-653-1908
Practice Address - Fax:502-371-0829
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1187101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1187OtherPUBLIC PROTECTION CABINET