Healthcare Provider Details

I. General information

NPI: 1285749903
Provider Name (Legal Business Name): DOUGLAS A LOCKE MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 VALLEY HI DR STE A
SACRAMENTO CA
95823-7076
US

IV. Provider business mailing address

6615 VALLEY HI DR STE A
SACRAMENTO CA
95823-7076
US

V. Phone/Fax

Practice location:
  • Phone: 916-681-6300
  • Fax:
Mailing address:
  • Phone: 916-681-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 27328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: