MEDICARE: GOODHEART PSYCHOLOGY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2180	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023508652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODHEART PSYCHOLOGY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 363
Second Line	:
City	:	LA CROSSE
State	:	KS
Zip	:	67548-0363
Country	:	US
Telephone Number	:	785-222-4276
Fax Number	:	785-222-4277

Provider Business Practice Location Address
First Line	:	940 N TYLER RD STE 201
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67212-3266
Country	:	US
Telephone Number	:	316-247-6288
Fax Number	:	316-444-6468

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST, OPERATOR
Name	:	KRISTIN L GOODHEART
Credential	:	PHD
Telephone Number	:	785-222-4276

Provider Enumeration Date	:	05/18/2018
Last Update Date	:	03/24/2026

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