Provider Demographics
NPI:1194007922
Name:WILLOUGHBY, CHERYL LYNN (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNN
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:HARRAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1030 ANDREWS HWY STE 108
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3817
Mailing Address - Country:US
Mailing Address - Phone:432-557-1775
Mailing Address - Fax:432-557-1775
Practice Address - Street 1:1030 ANDREWS HWY STE 108
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3817
Practice Address - Country:US
Practice Address - Phone:432-557-1775
Practice Address - Fax:432-557-1775
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional