Provider Demographics
NPI:1043538275
Name:LOCKE, HILLARY HAMILTON (PSYD)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:HAMILTON
Last Name:LOCKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 CENTRAL WAY STE 2
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5095
Mailing Address - Country:US
Mailing Address - Phone:208-237-1711
Mailing Address - Fax:
Practice Address - Street 1:4460 CENTRAL WAY STE 2
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-5095
Practice Address - Country:US
Practice Address - Phone:208-237-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202309103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical