Individual
LA SHAWN MARIE UNDERWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHR, LPC
Contact information
Practice address
5120 N SANTA FE AVE STE C, OKLAHOMA CITY, OK 73118-7510
(405) 529-6331
Mailing address
1901 NW 174TH ST, EDMOND, OK 73012-7068
(405) 529-6331
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6225
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200352330A
—
OK
Enumeration date
03/08/2010
Last updated
03/19/2018
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