Provider Demographics
NPI:1487960704
Name:JOHNSON, CINDY MICHELLE (MS, LMFT)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MRS
Other - First Name:CINDY
Other - Middle Name:MICHELLE
Other - Last Name:GOGGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:112 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5409
Mailing Address - Country:US
Mailing Address - Phone:575-590-3428
Mailing Address - Fax:
Practice Address - Street 1:112 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-5409
Practice Address - Country:US
Practice Address - Phone:575-590-3428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60561509106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM95057072Medicaid