Provider Demographics
NPI:1154834802
Name:BALCH, JENNIFER (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:BALCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10025 W. MARKHAM ST
Mailing Address - Street 2:STE 210
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2178
Mailing Address - Country:US
Mailing Address - Phone:501-663-5473
Mailing Address - Fax:501-801-1816
Practice Address - Street 1:10025 W MARKHAM ST
Practice Address - Street 2:STE 210
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2178
Practice Address - Country:US
Practice Address - Phone:501-663-5473
Practice Address - Fax:501-801-1816
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1895-M101Y00000X
AR3136-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1922323096Medicaid