Provider Demographics
NPI:1013034990
Name:LOCKWOOD, FAHLENE (LCSW)
Entity Type:Individual
Prefix:
First Name:FAHLENE
Middle Name:
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 HYACINTH ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-9556
Mailing Address - Country:US
Mailing Address - Phone:503-851-1048
Mailing Address - Fax:
Practice Address - Street 1:2075 NW GRANT AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4366
Practice Address - Country:US
Practice Address - Phone:541-368-3152
Practice Address - Fax:855-279-0612
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL82961041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator