Provider Demographics
NPI:1770905671
Name:LOCKARD, JOHN (MA, LPC, CAADC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LOCKARD
Suffix:
Gender:M
Credentials:MA, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:ALANSON
Mailing Address - State:MI
Mailing Address - Zip Code:49706-0402
Mailing Address - Country:US
Mailing Address - Phone:231-838-5112
Mailing Address - Fax:
Practice Address - Street 1:107 HOWARD ST STE B
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2409
Practice Address - Country:US
Practice Address - Phone:231-838-5112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-11
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006333101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health