Provider Demographics
NPI:1194932699
Name:DYCKMAN, LYDIA (MS)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:
Last Name:DYCKMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:710 BUFFALO ST
Mailing Address - Street 2:STE. 502
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-1933
Mailing Address - Country:US
Mailing Address - Phone:361-888-8834
Mailing Address - Fax:361-888-8837
Practice Address - Street 1:710 BUFFALO ST
Practice Address - Street 2:STE. 502
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-1933
Practice Address - Country:US
Practice Address - Phone:361-888-8834
Practice Address - Fax:361-888-8837
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19735101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health