Healthcare Provider Details

I. General information

NPI: 1245142025
Provider Name (Legal Business Name): BRYNLEE ANNE UNDERWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 BENNER BLDG 2
KYLE TX
78640-2220
US

IV. Provider business mailing address

502 COMMERCIAL LOOP APT 3101
SAN MARCOS TX
78666-1465
US

V. Phone/Fax

Practice location:
  • Phone: 855-782-7822
  • Fax:
Mailing address:
  • Phone: 817-312-6267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: