Provider Demographics
NPI:1255079604
Name:LOCKETT, DIANA LYNETTE (MA, QMHP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNETTE
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 W AGATITE AVE APT G
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6047
Mailing Address - Country:US
Mailing Address - Phone:901-859-1595
Mailing Address - Fax:
Practice Address - Street 1:281 S SCHMIDT RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2746
Practice Address - Country:US
Practice Address - Phone:630-447-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health