Provider Demographics
NPI:1417757063
Name:JOHNSON, CHLOE CREE (MC61651050)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:CREE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:MC61651050
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 HARRINGTON AVE NE APT S215
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-3422
Mailing Address - Country:US
Mailing Address - Phone:206-919-5073
Mailing Address - Fax:
Practice Address - Street 1:2420 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1322
Practice Address - Country:US
Practice Address - Phone:253-201-3831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61651050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health