Provider Demographics
NPI:1356500276
Name:LOCK, ELIZABETH GAIL (MA IIA)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:GAIL
Last Name:LOCK
Suffix:
Gender:F
Credentials:MA IIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BUSH CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7816
Mailing Address - Country:US
Mailing Address - Phone:270-783-0151
Mailing Address - Fax:
Practice Address - Street 1:60 BUSH CT
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7816
Practice Address - Country:US
Practice Address - Phone:270-783-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator