Provider Demographics
NPI:1134377583
Name:MENDENHALL, LAURA LEE (LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEE
Other - Last Name:KIEHLBAUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5105
Mailing Address - Country:US
Mailing Address - Phone:792-255-5414
Mailing Address - Fax:479-751-4898
Practice Address - Street 1:801 CARLTON ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5105
Practice Address - Country:US
Practice Address - Phone:479-255-5414
Practice Address - Fax:855-277-8988
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4944-M104100000X
AR4944-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker