Provider Demographics
NPI:1396927802
Name:CHEATHAM, DOUGLAS A (LMHC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:A
Last Name:CHEATHAM
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CREEKSIDE LOOP STE 102
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4874
Mailing Address - Country:US
Mailing Address - Phone:509-966-8775
Mailing Address - Fax:509-966-8775
Practice Address - Street 1:1701 CREEKSIDE LOOP STE 102
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4874
Practice Address - Country:US
Practice Address - Phone:509-966-8775
Practice Address - Fax:509-966-8775
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006227101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health