MEDICARE: MRS. SARAH ALYSE DETRICK LMFT

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	106H00000X	Marriage & Family Therapist	46458	CA

General Provider Information

NPI Number	:	1023136744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH ALYSE DETRICK LMFT

Provider Business Mailing Address
First Line	:	9001 HUXLEY DR
Second Line	:
City	:	PROVIDENCE VILLAGE
State	:	TX
Zip	:	76227-2180
Country	:	US
Telephone Number	:	661-444-1108
Fax Number	:

Provider Business Practice Location Address
First Line	:	9001 HUXLEY DR
Second Line	:
City	:	PROVIDENCE VILLAGE
State	:	TX
Zip	:	76227-2180
Country	:	US
Telephone Number	:	661-444-1108
Fax Number	:

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	04/07/2024

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