Provider Demographics
NPI:1790904910
Name:MANDEL-CARLEY, ELIABETH (LCSW, LMFT)
Entity Type:Individual
Prefix:
First Name:ELIABETH
Middle Name:
Last Name:MANDEL-CARLEY
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:MANDEL-CARLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, LMFT
Mailing Address - Street 1:5350 POPLAR AVE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3699
Mailing Address - Country:US
Mailing Address - Phone:901-683-1422
Mailing Address - Fax:901-683-1401
Practice Address - Street 1:5350 POPLAR AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3699
Practice Address - Country:US
Practice Address - Phone:901-683-1422
Practice Address - Fax:901-683-1401
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000000691041C0700X
TN0000000187106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist