Provider Demographics
NPI:1437483724
Name:MCLENDON, KATHERYN ODELL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHERYN
Middle Name:ODELL
Last Name:MCLENDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KATHERYN
Other - Middle Name:ODELL
Other - Last Name:TEAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2707 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7213
Mailing Address - Country:US
Mailing Address - Phone:870-972-4939
Mailing Address - Fax:870-972-4911
Practice Address - Street 1:2707 BROWNS LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7213
Practice Address - Country:US
Practice Address - Phone:870-972-4939
Practice Address - Fax:870-972-4911
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-20
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC68061041C0700X
TN49261041C0700X
AR8217-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR216472795Medicaid
MS302G706355Medicare UPIN
AR5B596Medicare UPIN
MS302I803503Medicare UPIN