Healthcare Provider Details

I. General information

NPI: 1639932437
Provider Name (Legal Business Name): THE UNDERSTORY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 SOUTH AVE UNIT 6
MEDIA PA
19063-3157
US

IV. Provider business mailing address

502 W 7TH ST STE 100
ERIE PA
16502-1333
US

V. Phone/Fax

Practice location:
  • Phone: 610-299-7451
  • Fax:
Mailing address:
  • Phone: 610-299-7451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: EMILY EVANS
Title or Position: OWNER
Credential: LCSW
Phone: 610-299-7451