Doctor Name: | MATTIE LOUISE LOCKE |
NPI Number: | 1114396397 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 106908 |
Business Practice Address: | 379 Fm 2972 W Rusk, TX - 757853666 |
Business Phone Number: | 9036835781 |
Business Fax Number: | |
Mailing Address: | 379 Fm 2972 W, RUSK |
State: | TX |
Postal Code: | 757853666 |
Phone Number: | 9036835781 |
Fax Number: | |
NPI Enumeration Date: | 09/17/2015 |
NPI Last Update Date: | 09/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SP0808X |
License Number: | 106908 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |