Healthcare Provider Details

I. General information

NPI: 1881558534
Provider Name (Legal Business Name): RICARDO CORONADO HERNANDEZ LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21252 SE 25TH ST
SAMMAMISH WA
98075-8024
US

IV. Provider business mailing address

21252 SE 25TH ST
SAMMAMISH WA
98075-8024
US

V. Phone/Fax

Practice location:
  • Phone: 425-477-9935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61612355
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: