Basic Information
| Provider Information | |||||||||
| NPI: | 1316152952 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIRT | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.H.P.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9701 SOUTHWEST DR | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722097125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015620514 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2 INNWOOD CIR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722112447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019547470 | ||||||||
| FaxNumber: | 5019547420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.