Provider Demographics
NPI:1356858856
Name:DIETRICK, NICK (LPC)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:DIETRICK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 S STONEBRIDGE DR STE 604
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8051
Mailing Address - Country:US
Mailing Address - Phone:972-839-0424
Mailing Address - Fax:
Practice Address - Street 1:3900 S STONEBRIDGE DR STE 604
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-8051
Practice Address - Country:US
Practice Address - Phone:469-734-8129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional