MEDICARE: CHERYL DUBBS DIELMAN LCSW-S,LPC-S,CEDS-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	S02020	TX
2	101YP2500X	Professional Counselor	05505	TX

General Provider Information

NPI Number	:	1851953723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL DUBBS DIELMAN LCSW-S,LPC-S,CEDS-S

Provider Business Mailing Address
First Line	:	3509 HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6862
Country	:	US
Telephone Number	:	817-731-3700
Fax Number	:	817-731-9547

Provider Business Practice Location Address
First Line	:	3509 HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6862
Country	:	US
Telephone Number	:	817-731-3700
Fax Number	:	817-731-9547

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	07/01/2019

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