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General NPI Number Information
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NPI Number | 1811287303
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Entity Type | Organization
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Legal Business Name | MANDY KLEIN LCSW, RPT-S
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 2913 KING ST STE 3
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City | JONESBORO
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State | AR
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Zip | 72401-5322
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Country | US
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Telephone | 870-275-7408
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Fax | 866-591-1451
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Provider Business Mailing Address
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Address Line | 3205 KIRBY WHITTEN RD STE 203D
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City | BARTLETT
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State | TN
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Zip | 38134-2853
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Country | US
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Telephone | 901-430-5009
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Fax | 901-284-0527
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Authorized Official
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Title or Position | OWNER
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Name | MANDY KLEIN
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Credential | LCSW, RPT-S
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Telephone | 901-430-5009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2001-C
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License Number State | AR
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