Active NPI
Nicky Underwood, LCSW
- Clinical Social Worker
- Beaumont, TX
National Provider Identifier
1245770197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 59986
- Practice address
- 3610 Stagg Dr
Beaumont, TX 77701-3713 - Phone
- (409) 730-4700
- Fax
- (409) 730-4701
- NPI assigned
- Feb 26, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 59986 | TX | Primary |
Addresses
Primary practice location
3610 Stagg Dr
Beaumont, TX 77701-3713
Mailing address
1941 East Rd
Houston, TX 77054-6010
Phone (713) 486-2700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59986 | TX | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
| Peace of Mind Counseling Service | Current | Accepting new patients |
Interoperability endpoints
- nickyunderwood@tdh.allscriptsdirect.net
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Adult Mental Health Clinic/Center
- Port Arthur, TX
- NPI 1114567690
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492646400000",
"number": "1245770197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1941 EAST RD",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770546010",
"telephone_number": "713-486-2700",
"fax_number": "713-486-2721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3610 STAGG DR",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777013713",
"telephone_number": "409-730-4700",
"fax_number": "409-730-4701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UNDERWOOD",
"first_name": "NICKY",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-02-26",
"last_updated": "2017-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "59986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, TX
- Onyekachi Enyinnaya Ukpabi Jr., PHARMD
- Ultimate Care Plus Non-Emergency Medical Transportation L.L.C
- Cristian U Umana, LPC
- Cheryl Anne Underhill, LPC
- Marni G Underwood, APRN
- Uni-Care Home Health, Inc.
- Unicare EMS LLC
- Unicare EMS LLC
- Unique Personal Care Transportation
- United Hands Adult Daycare, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.