Healthcare Provider Details

I. General information

NPI: 1255065892
Provider Name (Legal Business Name): GRACE UNDERWOOD LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ELLIOTT AVE W
SEATTLE WA
98119-4236
US

IV. Provider business mailing address

100 N HOWARD ST STE W
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 643-220-6708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61648911
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: