Provider Demographics
NPI:1932332095
Name:UNDERWOOD, MARGARET WAGNER (LCPC)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:WAGNER
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 FAIRMOUNT DR
Mailing Address - Street 2:MM103
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-6527
Mailing Address - Country:US
Mailing Address - Phone:303-564-8641
Mailing Address - Fax:
Practice Address - Street 1:8300 FAIRMOUNT DR
Practice Address - Street 2:MM103
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-6527
Practice Address - Country:US
Practice Address - Phone:303-564-8641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5123101YP2500X
MDLC5740101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO101YP2500XMedicaid