Healthcare Provider Details

I. General information

NPI: 1508073446
Provider Name (Legal Business Name): JENNIFER F LOCKHART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 LORETTA ST
LANSING MI
48911-5132
US

IV. Provider business mailing address

70 LAFAYETTE ST
PONTIAC MI
48342-2033
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-5661
  • Fax: 517-882-5673
Mailing address:
  • Phone: 248-338-7458
  • Fax: 248-338-7513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: