Healthcare Provider Details

I. General information

NPI: 1770413551
Provider Name (Legal Business Name): CHERYL JOHNSON LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N 16TH AVE STE G
YAKIMA WA
98902-7102
US

IV. Provider business mailing address

1460 N 16TH AVE STE G
YAKIMA WA
98902-7102
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-7750
  • Fax:
Mailing address:
  • Phone: 509-575-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70098799
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: