Provider Demographics
NPI:1952447898
Name:LOCKWOOD, KIRK (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:
Last Name:LOCKWOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 LA GRANADA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1314
Mailing Address - Country:US
Mailing Address - Phone:281-507-0267
Mailing Address - Fax:
Practice Address - Street 1:6610 LA GRANADA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-1314
Practice Address - Country:US
Practice Address - Phone:281-507-0267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23627103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030516102Medicaid
TX030516102Medicaid
TX579923Medicare UPIN