Healthcare Provider Details

I. General information

NPI: 1417757063
Provider Name (Legal Business Name): CHLOE CREE JOHNSON MC61651050
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 S UNION AVE
TACOMA WA
98405-1322
US

IV. Provider business mailing address

950 HARRINGTON AVE NE APT S215
RENTON WA
98056-3422
US

V. Phone/Fax

Practice location:
  • Phone: 253-201-3831
  • Fax:
Mailing address:
  • Phone: 206-919-5073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61651050
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: