Provider Demographics
NPI:1508073446
Name:LOCKHART, JENNIFER F
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:F
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2033
Mailing Address - Country:US
Mailing Address - Phone:248-338-7458
Mailing Address - Fax:248-338-7513
Practice Address - Street 1:6040 LORETTA ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-5132
Practice Address - Country:US
Practice Address - Phone:517-882-5661
Practice Address - Fax:517-882-5673
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health