Provider Demographics
NPI:1912343401
Name:MICHALAK, CARA LYNN (MED, LPC-CR)
Entity Type:Individual
Prefix:MISS
First Name:CARA
Middle Name:LYNN
Last Name:MICHALAK
Suffix:
Gender:F
Credentials:MED, LPC-CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 GOUGLER AVE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2401
Mailing Address - Country:US
Mailing Address - Phone:330-677-4124
Mailing Address - Fax:330-677-4134
Practice Address - Street 1:143 GOUGLER AVE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2401
Practice Address - Country:US
Practice Address - Phone:330-677-4124
Practice Address - Fax:330-677-4134
Is Sole Proprietor?:No
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0500231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health