Provider Demographics
NPI:1124139407
Name:GOODHEART, CHERYL (LPC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:GOODHEART
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 1:300 S CALHOUN
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-3659
Mailing Address - Country:US
Mailing Address - Phone:870-234-0739
Mailing Address - Fax:
Practice Address - Street 1:200 PECAN AVE
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2774
Practice Address - Country:US
Practice Address - Phone:870-234-0739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9512040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T719OtherBCBS