Provider Demographics
NPI:1871926345
Name:UNDERWOOD, MARTHA ANN (MED, LPC)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 N CRAYCROFT RD
Mailing Address - Street 2:STE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2811
Mailing Address - Country:US
Mailing Address - Phone:520-514-2211
Mailing Address - Fax:520-514-2215
Practice Address - Street 1:2224 N CRAYCROFT RD
Practice Address - Street 2:STE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2811
Practice Address - Country:US
Practice Address - Phone:520-514-2211
Practice Address - Fax:520-514-2215
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional