Healthcare Provider Details

I. General information

NPI: 1376968164
Provider Name (Legal Business Name): SUSAN UNDERWOOD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6368 W RUSHMORE WAY UNIT B
FLORENCE AZ
85132-5685
US

IV. Provider business mailing address

6368 W RUSHMORE WAY UNIT B
FLORENCE AZ
85132-5685
US

V. Phone/Fax

Practice location:
  • Phone: 520-849-0841
  • Fax:
Mailing address:
  • Phone: 520-849-0841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4462
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: