Healthcare Provider Details

I. General information

NPI: 1427460229
Provider Name (Legal Business Name): ROBERT LOCK L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HINDS BEHAVIORAL HEALTH SERVICES 3450 HWY 80 W
JACKSON MS
39209-4443
US

IV. Provider business mailing address

828 BULLRUN CIR
BYRAM MS
39272-4443
US

V. Phone/Fax

Practice location:
  • Phone: 601-321-2400
  • Fax: 601-985-5174
Mailing address:
  • Phone: 601-519-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1861
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: