Provider Demographics
NPI:1538286430
Name:LOCKHART, ANDREA (PHD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 EDISON PL
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8021
Mailing Address - Country:US
Mailing Address - Phone:720-281-9101
Mailing Address - Fax:
Practice Address - Street 1:325 W SOUTH BOULDER RD STE 6
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1130
Practice Address - Country:US
Practice Address - Phone:720-808-0931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17555103TC0700X
COPSY.0004922103TC0700X
CAPSY 17555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical