Provider Demographics
NPI:1295010478
Name:LOCKLEY, MEGAN ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELAINE
Last Name:LOCKLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 BROADMOOR PL
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-3321
Mailing Address - Country:US
Mailing Address - Phone:228-669-9483
Mailing Address - Fax:
Practice Address - Street 1:509 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4619
Practice Address - Country:US
Practice Address - Phone:228-875-6113
Practice Address - Fax:228-875-9065
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM7215101YP2500X
MSC7215101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018213Medicaid