Healthcare Provider Details

I. General information

NPI: 1811287303
Provider Name (Legal Business Name): MANDY KLEIN LCSW, RPT-S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 KING ST STE 3
JONESBORO AR
72401-5322
US

IV. Provider business mailing address

3205 KIRBY WHITTEN RD STE 203D
BARTLETT TN
38134-2853
US

V. Phone/Fax

Practice location:
  • Phone: 870-275-7408
  • Fax: 866-591-1451
Mailing address:
  • Phone: 901-430-5009
  • Fax: 901-284-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2001-C
License Number StateAR

VIII. Authorized Official

Name: MANDY KLEIN
Title or Position: OWNER
Credential: LCSW, RPT-S
Phone: 901-430-5009