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General NPI Number Information
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NPI Number | 1356413462
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Entity Type | Individual
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Provider Name | KATHIE C UNDERHILL LMHC, CEAP
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1639 BEACH BLVD SUITE 5
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-2603
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Country | US
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Telephone | 904-635-9904
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Fax | 904-739-9762
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Provider Business Mailing Address
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Address Line | 2609 DUPONT AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2632
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Country | US
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Telephone | 904-635-9904
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Fax | 904-739-9762
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH4130
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License Number State | FL
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