MEDICARE: MRS. GEORGINA JANELL UNDERWOOD

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	101YM0800X	Mental Health Counselor
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1912371154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GEORGINA JANELL UNDERWOOD

Provider Business Mailing Address
First Line	:	4204 SE 49TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-2147
Country	:	US
Telephone Number	:	405-250-1878
Fax Number	:

Provider Business Practice Location Address
First Line	:	4204 SE 49TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-2147
Country	:	US
Telephone Number	:	405-250-1878
Fax Number	:

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

Provider Enumeration Date	:	11/27/2015
Last Update Date	:	11/27/2015

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