Individual
MR. TANNER PAYNE UNDERWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC/MH
Contact information
Practice address
1015 WATERWOOD PARKWAY, BUILDING G, SUITE H-1, EDMOND, OK 73034
(405) 831-4122
Mailing address
4733 ROSEWOOD CT, NOBLE, OK 73068-5522
(405) 831-4122
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1318
OK
101YM0800X
Mental Health Counselor
1318
OK
Other
Enumeration date
03/06/2015
Last updated
11/05/2020
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