Tanner Payne Underwood, LADC/MH

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1318 Issued in OK

Practice address

1015 Waterwood Parkway
Building G, Suite H-1
Edmond, OK 73034

Phone

(405) 831-4122

NPI assigned

Mar 6, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1326431990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4733 ROSEWOOD CT",
            "city": "NOBLE",
            "state": "OK",
            "postal_code": "730685522",
            "telephone_number": "405-831-4122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 WATERWOOD PARKWAY",
            "address_2": "BUILDING G, SUITE H-1",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "73034",
            "telephone_number": "405-831-4122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNDERWOOD",
        "first_name": "TANNER",
        "middle_name": "PAYNE",
        "name_prefix": "Mr.",
        "credential": "LADC/MH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-06",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "1318",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OK",
            "license": "1318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Uco Student Health Phcy
• Johnny Ughanze, MHR, LPCC
• Dana Chanelle Ugwu, M.D., MPH
• Rukhsar Ullah
• Langston Underwood
• Unique Outcome, LLC
• University Health Services
• University of Central Oklahoma
• Bradley Holloman Unruh
• Uplift Pelvic Health LLC

• Addiction (Substance Use Disorder) Counselor in Edmond, OK
• Providers in Edmond, OK by specialty
• Addiction (Substance Use Disorder) Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.