Provider Demographics
NPI:1376640029
Name:LOCKE, PATRICIA A (PSYD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
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 1:1011 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-4927
Mailing Address - Country:US
Mailing Address - Phone:936-645-1722
Mailing Address - Fax:
Practice Address - Street 1:1011 LEE AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-4927
Practice Address - Country:US
Practice Address - Phone:936-645-1722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33236103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183249504Medicaid
MEMM7978OtherNHIC
MEMM7978OtherNHIC