Healthcare Provider Details

I. General information

NPI: 1710201611
Provider Name (Legal Business Name): JAMES G UNDERHILL PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 ANSLEY BLVD
ALEXANDRIA LA
71303-3782
US

IV. Provider business mailing address

PO BOX 204181
AUSTIN TX
78720-4181
US

V. Phone/Fax

Practice location:
  • Phone: 318-545-7255
  • Fax:
Mailing address:
  • Phone: 512-484-0574
  • Fax: 512-879-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number34475
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34475
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMP.000041
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number34475
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: