Provider Demographics
NPI:1184802175
Name:GODLEY, CHERYL A (PH D)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:A
Last Name:GODLEY
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 CY AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3572
Mailing Address - Country:US
Mailing Address - Phone:307-234-0500
Mailing Address - Fax:
Practice Address - Street 1:1607 CY AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3572
Practice Address - Country:US
Practice Address - Phone:307-234-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY274103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW307237Medicare PIN