Provider Demographics
NPI:1265065478
Name:DETRICK, LINGYU (LMHCT)
Entity type:Individual
Prefix:
First Name:LINGYU
Middle Name:
Last Name:DETRICK
Suffix:
Gender:F
Credentials:LMHCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 S LINN ST STE 40
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-1608
Mailing Address - Country:US
Mailing Address - Phone:319-849-5069
Mailing Address - Fax:
Practice Address - Street 1:332 S LINN ST STE 40
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-1608
Practice Address - Country:US
Practice Address - Phone:319-849-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-16
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health