{
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"NPI": "1811287303",
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "MANDY KLEIN LCSW, RPT-S",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": "6",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3205 KIRBY WHITTEN RD STE 203D",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BARTLETT",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38134-2853",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "901-430-5009",
"MailingAddressFaxNumber": "901-284-0527",
"FirstLinePracticeLocationAddress": "2913 KING ST",
"SecondLinePracticeLocationAddress": "STE 3",
"PracticeLocationAddressCityName": "JONESBORO",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72401-5322",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "870-275-7408",
"PracticeLocationAddressFaxNumber": "866-591-1451",
"EnumerationDate": "04/18/2011",
"LastUpdateDate": "09/24/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KLEIN",
"AuthorizedOfficialFirstName": "MANDY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW, RPT-S",
"AuthorizedOfficialTelephoneNumber": "901-430-5009",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "2001-C",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}