Provider Demographics
NPI:1275184202
Name:JAKANA, CHERYL (LMHCA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:JAKANA
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 BELLEVUE WAY NE STE 8A-334
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4280
Mailing Address - Country:US
Mailing Address - Phone:425-298-3007
Mailing Address - Fax:
Practice Address - Street 1:1621 114TH AVE SE STE 221
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6905
Practice Address - Country:US
Practice Address - Phone:425-691-0728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC.60995229101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty