Provider Demographics
NPI:1649741554
Name:LOCKLEAR, JEAN ANNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ANNETTE
Last Name:LOCKLEAR
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 1:721 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1205
Mailing Address - Country:US
Mailing Address - Phone:405-553-1164
Mailing Address - Fax:405-553-1190
Practice Address - Street 1:721 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1205
Practice Address - Country:US
Practice Address - Phone:405-553-1164
Practice Address - Fax:405-553-1190
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK49321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical