Provider Demographics
NPI:1265056139
Name:RAU, CHERYL RENEE (MA, LMHCA)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:RENEE
Last Name:RAU
Suffix:
Gender:F
Credentials:MA, LMHCA
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 861
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-0861
Mailing Address - Country:US
Mailing Address - Phone:360-961-4993
Mailing Address - Fax:
Practice Address - Street 1:1920 MAIN ST STE 18
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9472
Practice Address - Country:US
Practice Address - Phone:360-961-4993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61007008101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health