Provider Demographics
NPI:1013004977
Name:LOCKERT, KIMBERLEY (PCC)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:LOCKERT
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 SANDUCKY ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805
Mailing Address - Country:US
Mailing Address - Phone:419-289-1876
Mailing Address - Fax:419-281-6430
Practice Address - Street 1:259 SANDUCKY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805
Practice Address - Country:US
Practice Address - Phone:419-289-1876
Practice Address - Fax:419-281-6430
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE4285101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health