Provider Demographics
NPI:1184953416
Name:WHITMORE, JENNIFER JOYCE (PHD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JOYCE
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:JOYCE
Other - Last Name:VAN SCOYOC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:305 S PALM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5432
Mailing Address - Country:US
Mailing Address - Phone:501-686-9000
Mailing Address - Fax:501-686-9276
Practice Address - Street 1:305 S PALM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5432
Practice Address - Country:US
Practice Address - Phone:501-686-9000
Practice Address - Fax:501-686-9276
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR09-07P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical