Provider Demographics
NPI:1033834924
Name:LOCKHART, TIMM C (LPC)
Entity Type:Individual
Prefix:
First Name:TIMM
Middle Name:C
Last Name:LOCKHART
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 ALGONQUIN TRL
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1436
Mailing Address - Country:US
Mailing Address - Phone:203-364-7707
Mailing Address - Fax:
Practice Address - Street 1:44 ALGONQUIN TRL
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1436
Practice Address - Country:US
Practice Address - Phone:203-364-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5769OtherDEPARTMENT OF PUBLIC HEALTH