Healthcare Provider Details

I. General information

NPI: 1740131598
Provider Name (Legal Business Name): CHERYL RUNKLE AMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 LONETREE BLVD STE 203F
ROCKLIN CA
95765-3794
US

IV. Provider business mailing address

PO BOX 1063
ROCKLIN CA
95677-1063
US

V. Phone/Fax

Practice location:
  • Phone: 916-250-3108
  • Fax:
Mailing address:
  • Phone: 916-581-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: