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NPI Code Detail

MEDICARE: MALLIE DANIELLE UNDERWOOD LCSW

MEDICARE: MALLIE DANIELLE UNDERWOOD LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker59323TX

General Provider Information

NPI Number : 1447716246
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLIE DANIELLE UNDERWOOD LCSW
Provider Business Mailing Address
First Line : 1221 W BEN WHITE BLVD STE 210A
Second Line :
City : AUSTIN
State : TX
Zip : 78704-7182
Country : US
Telephone Number : 512-960-4533
Fax Number : 512-703-1394
Provider Business Practice Location Address
First Line : 1221 W BEN WHITE BLVD
Second Line : STE 210A
City : AUSTIN
State : TX
Zip : 78704-7182
Country : US
Telephone Number : 512-472-4357
Fax Number : 512-703-1394
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2019
Last Update Date : 02/28/2020

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Directions to “ MALLIE DANIELLE UNDERWOOD LCSW” Practice Location

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