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General NPI Number Information
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NPI Number | 1942591292
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Entity Type | Organization
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Legal Business Name | UNDERWOOD PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 1700 UPS DR STE 208
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City | LOUISVILLE
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State | KY
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Zip | 40223-5014
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Country | US
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Telephone | 502-412-9197
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Fax |
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Provider Business Mailing Address
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Address Line | 17322 CURRY BRANCH RD
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City | LOUISVILLE
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State | KY
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Zip | 40245-7500
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. ROBERT ALLEN UNDERWOOD
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Credential | PH.D.
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Telephone | 502-314-0546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1330
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License Number State | KY
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