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NPI Code Detail

MEDICARE: JOLENE UNDERWOOD MA, LPC-ASSOCIATE

MEDICARE: JOLENE UNDERWOOD MA, LPC-ASSOCIATE
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
1101YM0800XMental Health Counselor87828TX

General Provider Information

NPI Number : 1659080653
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOLENE UNDERWOOD MA, LPC-ASSOCIATE
Provider Business Mailing Address
First Line : 4960 WALKING STICK RD APT O
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21043-8058
Country : US
Telephone Number : 512-627-1024
Fax Number :
Provider Business Practice Location Address
First Line : 4960 WALKING STICK RD APT O
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21043-8058
Country : US
Telephone Number : 512-627-1024
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2022
Last Update Date : 11/17/2022

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