Gary Underwood, LPC – Professional Counselor

Key facts

NPI: 1861597650
Entity type: Individual (NPI type 1)
Primary specialty: Professional Counselor 101YP2500X
License: 000254 (MO)
Practice address: 208 Broadway
Marble Hill, MO 63764
Phone: (573) 238-1127
Fax: (573) 238-1171
NPI assigned: Sep 14, 2006
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

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.

Community Counseling Center Mental Health Clinic/Center (Including Community Mental Health Center) · Cape Girardeau, MO · NPI 1235244757

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
000254	MO	MD	Professional Counselor

Practice roles

Organization	Specialty	Status	New patients
Community Counseling Center		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Professional Counselor	101YP2500X	000254	MO	Yes

Addresses

Primary practice location

208 Broadway
Marble Hill, MO 63764

Mailing address

402 S Silver Springs Rd
Cape Girardeau, MO 63703-7536
Phone (573) 334-1100

Other identifiers

Identifier	Type	State	Issuer
19616	Other	MO	BLUE CROSS BLUE SHIELD

Other providers in Marble Hill, MO

All providers in Marble Hill, MO · Professional Counselor in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.