Provider Demographics
NPI:1053846220
Name:CERMAK, MICHELE (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:CERMAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:JUHASZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 SUNFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2590
Mailing Address - Country:US
Mailing Address - Phone:817-319-2935
Mailing Address - Fax:
Practice Address - Street 1:1307 8TH AVE STE 310
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4140
Practice Address - Country:US
Practice Address - Phone:817-319-2935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical