Provider Demographics
NPI:1952624215
Name:GOODMAN, SHERYL ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:ANNE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:132 STETSON TRL
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-4770
Mailing Address - Country:US
Mailing Address - Phone:512-585-3048
Mailing Address - Fax:512-692-2723
Practice Address - Street 1:4749 WILLIAMS DR
Practice Address - Street 2:SUITE 336
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-3710
Practice Address - Country:US
Practice Address - Phone:512-945-3191
Practice Address - Fax:512-692-2723
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65930101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional