MEDICARE: KAREN LAJUNE UNDERWOOD PH.D, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	7440	LA
2	101YP2500X	Professional Counselor	7440	LA
3	101Y00000X	Counselor	7440	LA
4	101YM0800X	Mental Health Counselor	7440	LA

General Provider Information

NPI Number	:	1336614569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LAJUNE UNDERWOOD PH.D, LPC

Provider Business Mailing Address
First Line	:	PO BOX 792
Second Line	:
City	:	BASTROP
State	:	LA
Zip	:	71221-0792
Country	:	US
Telephone Number	:	318-283-8887
Fax Number	:	318-281-2559

Provider Business Practice Location Address
First Line	:	501 DURHAM ST
Second Line	:
City	:	BASTROP
State	:	LA
Zip	:	71220-5012
Country	:	US
Telephone Number	:	318-556-8440
Fax Number	:	318-556-8449

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	10/24/2024

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