Healthcare Provider Details

I. General information

NPI: 1295825859
Provider Name (Legal Business Name): JANICE CHURCH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CHILDRENS WAY # 401
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

11 CHILDRENS WAY # 401
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-3810
  • Fax: 501-364-3416
Mailing address:
  • Phone: 501-364-3810
  • Fax: 501-364-3416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number92-1P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: