Provider Demographics
NPI:1497176093
Name:SMITH, CHERYL FUNSCH (PHD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:FUNSCH
Last Name:SMITH
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 1:169 PRINCESS CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1422
Mailing Address - Country:US
Mailing Address - Phone:615-618-5166
Mailing Address - Fax:
Practice Address - Street 1:2031 N GREEN ACRES RD STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2619
Practice Address - Country:US
Practice Address - Phone:615-618-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-27
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008859L103T00000X
TN3206103TC0700X
AR20-07P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist