Provider Demographics
NPI:1922537695
Name:STORMENT, REBECCA MEREDITH (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MEREDITH
Last Name:STORMENT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:MEREDITH
Other - Last Name:STORMENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:300 N COLLEGE AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-4381
Mailing Address - Country:US
Mailing Address - Phone:479-348-4221
Mailing Address - Fax:479-334-3223
Practice Address - Street 1:300 N COLLEGE AVE STE 306
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-4381
Practice Address - Country:US
Practice Address - Phone:479-348-4221
Practice Address - Fax:479-334-3223
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202134103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR202134OtherSTATE PSYCHOLOGY LICENSE