Provider Demographics
NPI:1871632471
Name:LOCKHART, MARIANNE M
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:M
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 1:104 BEALL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5082
Mailing Address - Country:US
Mailing Address - Phone:318-442-6270
Mailing Address - Fax:
Practice Address - Street 1:242 SHAMROCK ST.
Practice Address - Street 2:UNIT 1
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-484-6850
Practice Address - Fax:318-484-6506
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2321101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health