Michaela J Detrick, LPC, CAADC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PC013722 Issued in PA

Practice address

1521 Washington Blvd
Williamsport, PA 17701-5426

Phone

(570) 322-5051

Fax

(570) 322-6788

NPI assigned

Sep 14, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  PA

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1144990961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 N LOYALSOCK AVE",
            "city": "MONTOURSVILLE",
            "state": "PA",
            "postal_code": "177541022",
            "telephone_number": "570-220-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 WASHINGTON BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177015426",
            "telephone_number": "570-322-5051",
            "fax_number": "570-322-6788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETRICK",
        "first_name": "MICHAELA",
        "middle_name": "J",
        "credential": "LPC, CAADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-14",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "PA",
            "license": "PC013722",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC013722",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "PA",
            "license": "10091",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Demay, M.D.
• Aaron M Dembeck, MS, P.T.
• Sarah Ellen Deppen, MED
• Erica L. Derrick, OTR/L
• Bradley Deters, CRNA
• Ellen Judith Detweiler, P.T.
• Stephanie Deviney
• Kathryn Clair Devoir, PA-C
• Sylvia Dewire, PHARMD
• Jacob Kyle Dgien, PT, DPT

• Professional Counselor in Williamsport, PA
• Providers in Williamsport, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.