Healthcare Provider Details

I. General information

NPI: 1043379498
Provider Name (Legal Business Name): KAREN K UNDERWOOD PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 N CHELTON RD
COLORADO SPRINGS CO
80909-1009
US

IV. Provider business mailing address

2815 N CHELTON RD
COLORADO SPRINGS CO
80909-1009
US

V. Phone/Fax

Practice location:
  • Phone: 719-338-7228
  • Fax: 719-630-1997
Mailing address:
  • Phone: 719-474-7425
  • Fax: 719-630-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number1820
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1820
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number1820
License Number StateCO

VIII. Authorized Official

Name: DR. KAREN K UNDERWOOD
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 719-338-7228