Provider Demographics
NPI:1699155945
Name:WITTHUHN, MANDY JEAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MANDY
Middle Name:JEAN
Last Name:WITTHUHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 N DUQUESNE RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-1509
Mailing Address - Country:US
Mailing Address - Phone:417-782-1443
Mailing Address - Fax:417-782-3240
Practice Address - Street 1:1230 N DUQUESNE RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-1509
Practice Address - Country:US
Practice Address - Phone:417-782-1443
Practice Address - Fax:417-782-3240
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180037881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical