Active NPI
Deanna Lynn Goggans, LPC
- Professional Counselor
- Russellville, AR
National Provider Identifier
1376794503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- P1109068
- Practice address
- 110 Skyline Dr
Russellville, AR 72801-3362 - Phone
- (479) 968-1298
- Fax
- (479) 968-6053
- NPI assigned
- Oct 7, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | P1109068 | AR | |
| Professional Counselor | 101YP2500X | P1109068 | AR | Primary |
Addresses
Primary practice location
110 Skyline Dr
Russellville, AR 72801-3362
Mailing address
2400 S 48TH St
Springdale, AR 72762-6683
Phone (479) 750-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 227036719 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P1109068 | AR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587513600000",
"number": "1376794503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 S 48TH ST",
"city": "SPRINGDALE",
"state": "AR",
"postal_code": "727626683",
"telephone_number": "479-750-2020",
"fax_number": "479-750-4843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 SKYLINE DR",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728013362",
"telephone_number": "479-968-1298",
"fax_number": "479-968-6053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOGGANS",
"first_name": "DEANNA",
"middle_name": "LYNN",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-07",
"last_updated": "2020-04-22",
"certification_date": "2020-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AR",
"license": "P1109068",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AR",
"license": "P1109068",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "227036719",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Russellville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.