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General NPI Number Information
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NPI Number | 1144718149
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Entity Type | Individual
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Provider Name | BRANDON L UNDERWOOD LPC
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Gender | Male
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 11 S CAPITOL ST
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City | PEKIN
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State | IL
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Zip | 61554-4106
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Country | US
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Telephone | 309-346-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 EAGLE WAY
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City | CHICAGO
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State | IL
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Zip | 60678-1032
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Country | US
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Telephone | 630-717-2258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 180.007015
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180007015
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License Number State | IL
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