Provider Demographics
NPI:1619416914
Name:RETIC, CHERYL ANN (LMFT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:RETIC
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5945
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98064-5945
Mailing Address - Country:US
Mailing Address - Phone:253-653-9961
Mailing Address - Fax:425-473-1220
Practice Address - Street 1:15 S GRADY WAY STE 632
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3218
Practice Address - Country:US
Practice Address - Phone:253-653-9961
Practice Address - Fax:425-473-1220
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60807537106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist