Provider Demographics
NPI:1548464852
Name:VON STORCH, JANELLE RURIKO (LPC)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:RURIKO
Last Name:VON STORCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 SHADOW VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3255
Mailing Address - Country:US
Mailing Address - Phone:501-772-4719
Mailing Address - Fax:
Practice Address - Street 1:5507 RANCH DR STE 207
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-0043
Practice Address - Country:US
Practice Address - Phone:501-291-3732
Practice Address - Fax:501-251-1091
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0806052101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional