Provider Demographics
NPI:1023558178
Name:LOCKLIN, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LOCKLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 SISKIYOU BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2151
Mailing Address - Country:US
Mailing Address - Phone:541-482-1718
Mailing Address - Fax:
Practice Address - Street 1:611 SISKIYOU BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2151
Practice Address - Country:US
Practice Address - Phone:541-482-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)