Healthcare Provider Details

I. General information

NPI: 1780517540
Provider Name (Legal Business Name): KIERSTYN JUDIA LOCKEY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 DAWN DR STE 101
GEORGETOWN TX
78628-2822
US

IV. Provider business mailing address

3008 DAWN DR STE 101
GEORGETOWN TX
78628-2822
US

V. Phone/Fax

Practice location:
  • Phone: 512-966-5405
  • Fax:
Mailing address:
  • Phone: 512-966-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number98024
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: