Healthcare Provider Details

I. General information

NPI: 1306862966
Provider Name (Legal Business Name): MANDY KLEIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDY ERWIN LCSW

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 KIRBY WHITTEN 203 SUITE D
BARTLETT TN
38134-2853
US

IV. Provider business mailing address

3030 BRUNSWICK RD
BARTLETT TN
38133-4106
US

V. Phone/Fax

Practice location:
  • Phone: 901-430-5009
  • Fax: 901-284-0527
Mailing address:
  • Phone: 901-531-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2001-C
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0000006270
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: