Provider Demographics
NPI:1851953723
Name:DIELMAN, CHERYL DUBBS (LCSW-S,LPC-S,CEDS-S)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:DUBBS
Last Name:DIELMAN
Suffix:
Gender:F
Credentials:LCSW-S,LPC-S,CEDS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 HULEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6862
Mailing Address - Country:US
Mailing Address - Phone:817-731-3700
Mailing Address - Fax:817-731-9547
Practice Address - Street 1:3509 HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6862
Practice Address - Country:US
Practice Address - Phone:817-731-3700
Practice Address - Fax:817-731-9547
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS020201041C0700X
TX05505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical