Provider Demographics
NPI:1023136744
Name:DETRICK, SARAH ALYSE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ALYSE
Last Name:DETRICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 HUXLEY DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2180
Mailing Address - Country:US
Mailing Address - Phone:661-444-1108
Mailing Address - Fax:
Practice Address - Street 1:9001 HUXLEY DR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:76227-2180
Practice Address - Country:US
Practice Address - Phone:661-444-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46458106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist