Provider Demographics
NPI:1073614814
Name:LOCKARD, ANNA JOAN (MA LMHC)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:JOAN
Last Name:LOCKARD
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 STEVENSON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2647
Mailing Address - Country:US
Mailing Address - Phone:360-802-0110
Mailing Address - Fax:
Practice Address - Street 1:1110 STEVENSON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2647
Practice Address - Country:US
Practice Address - Phone:360-802-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005947101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
273748OtherVALUE OPTIONS
WALO3958OtherPUYALLUP WA REGENCY
WALO8689OtherENUMCLAW WA REGENCY