Provider Demographics
NPI:1306862966
Name:KLEIN, MANDY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:ERWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3030 BRUNSWICK RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4106
Mailing Address - Country:US
Mailing Address - Phone:901-531-1950
Mailing Address - Fax:
Practice Address - Street 1:3205 KIRBY WHITTEN 203 SUITE D
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2853
Practice Address - Country:US
Practice Address - Phone:901-430-5009
Practice Address - Fax:901-284-0527
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2001-C1041C0700X
TN00000062701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y793OtherBLUECROSS PROVIDER NUMBER
AR5Y793Medicare PIN