Provider Demographics
NPI:1619416914
Name:RETIC, CHERYL ANN (LMFTA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:RETIC
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33507 9TH AVE S STE H2
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6638
Mailing Address - Country:US
Mailing Address - Phone:253-620-0605
Mailing Address - Fax:
Practice Address - Street 1:33507 9TH AVE S STE H2
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6638
Practice Address - Country:US
Practice Address - Phone:253-620-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60461809106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist