MEDICARE: LISA UNDERWOOD RMHCI

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
1	101YM0800X	Mental Health Counselor	IMH27154	FL

General Provider Information

NPI Number	:	1770375305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA UNDERWOOD RMHCI

Provider Business Mailing Address
First Line	:	18390 HUNTERS GLEN RD
Second Line	:
City	:	N FT MYERS
State	:	FL
Zip	:	33917-4754
Country	:	US
Telephone Number	:	239-229-9284
Fax Number	:

Provider Business Practice Location Address
First Line	:	18390 HUNTERS GLEN RD
Second Line	:
City	:	N FT MYERS
State	:	FL
Zip	:	33917-4754
Country	:	US
Telephone Number	:	239-229-9284
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2025
Last Update Date	:	05/20/2025

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