Provider Demographics
NPI:1205132065
Name:EXECUTIVE PRODUCERS
Entity type:Organization
Organization Name:EXECUTIVE PRODUCERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKART
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-800-5878
Mailing Address - Street 1:8413 PALO DURO CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-6842
Mailing Address - Country:US
Mailing Address - Phone:972-800-5878
Mailing Address - Fax:972-386-8597
Practice Address - Street 1:4150 INTERNATIONAL PLZ
Practice Address - Street 2:STE 600
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4892
Practice Address - Country:US
Practice Address - Phone:972-800-5878
Practice Address - Fax:972-386-8597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34392103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty