Provider Demographics
NPI:1003386608
Name:LOCKETT, DEVIN A (BMET, CE, CNT, CBPTP)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:A
Last Name:LOCKETT
Suffix:
Gender:M
Credentials:BMET, CE, CNT, CBPTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8306 WILSHIRE BLVD. SUITE 777
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211
Mailing Address - Country:US
Mailing Address - Phone:424-204-2382
Mailing Address - Fax:
Practice Address - Street 1:916 N, MOUNTAIN AVE. SUITE D-1
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-608-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90683101YM0800X
246ZE0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health