Healthcare Provider Details

I. General information

NPI: 1336614569
Provider Name (Legal Business Name): KAREN LAJUNE UNDERWOOD PH.D, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN LAJUNE UNDERWOOD

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DURHAM ST
BASTROP LA
71220-5012
US

IV. Provider business mailing address

PO BOX 792
BASTROP LA
71221-0792
US

V. Phone/Fax

Practice location:
  • Phone: 318-556-8440
  • Fax: 318-556-8449
Mailing address:
  • Phone: 318-283-8887
  • Fax: 318-281-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number7440
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7440
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7440
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7440
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: