Provider Demographics
NPI:1407817695
Name:SIMON, CHERYL LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LYNN
Last Name:SIMON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INNWOOD CIR
Mailing Address - Street 2:#124
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2447
Mailing Address - Country:US
Mailing Address - Phone:501-663-5075
Mailing Address - Fax:
Practice Address - Street 1:1 INNWOOD CIR
Practice Address - Street 2:#124
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2447
Practice Address - Country:US
Practice Address - Phone:501-663-5075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR86-19P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical