Provider Demographics
NPI:1457720062
Name:UNDERWOOD, EMILY (PHARMD, LPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:
Credentials:PHARMD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 N FAIRFIELD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2651
Mailing Address - Country:US
Mailing Address - Phone:927-272-0187
Mailing Address - Fax:
Practice Address - Street 1:1255 N FAIRFIELD RD STE 102
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2651
Practice Address - Country:US
Practice Address - Phone:618-263-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439364183500000X
IL051.299008183500000X
OHC.2405701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No183500000XPharmacy Service ProvidersPharmacist