Healthcare Provider Details

I. General information

NPI: 1154238830
Provider Name (Legal Business Name): SUSAN UNDERWOOD MARRIAGE AND FAMILY THERAPY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 EUREKA AVE STE B4
YORBA LINDA CA
92886-3368
US

IV. Provider business mailing address

4811 EUREKA AVE STE B4
YORBA LINDA CA
92886-3368
US

V. Phone/Fax

Practice location:
  • Phone: 714-455-9033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD ALI
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 210-503-0525