Individual
EJ UNDERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 ENTERPRISE DR, WARSAW, IN 46580-1204
(574) 268-0448
Mailing address
6202 CONSTITUTION DR STE E, FORT WAYNE, IN 46804-1583
(260) 432-0066
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/29/2020
Last updated
04/29/2020
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