Provider Demographics
NPI:1063036176
Name:LOCKHART, EZRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:EZRA
Middle Name:
Last Name:LOCKHART
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13918 E MISSISSIPPI AVE STE 60-638
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3603
Mailing Address - Country:US
Mailing Address - Phone:888-201-0547
Mailing Address - Fax:
Practice Address - Street 1:58087 BETTY LEE DRIVE
Practice Address - Street 2:
Practice Address - City:MOFFAT
Practice Address - State:CO
Practice Address - Zip Code:81143
Practice Address - Country:US
Practice Address - Phone:303-929-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0002241106H00000X
COACD.0001774101YA0400X
HIMFT-879106H00000X
LAMFT1500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)