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General NPI Number Information
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NPI Number | 1174927743
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Entity Type | Organization
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Legal Business Name | LOCKETT ENTERPRISES, LLC
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Dates
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Enumeration Date | 10/10/2014
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 230 W WELLS ST SUITE 214
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City | MILWAUKEE
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State | WI
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Zip | 53203-1866
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Country | US
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Telephone | 414-839-8994
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Fax | 414-223-3817
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Provider Business Mailing Address
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Address Line | 230 W WELLS ST SUITE 214
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City | MILWAUKEE
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State | WI
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Zip | 53203-1866
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Country | US
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Telephone | 414-839-8994
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Fax | 414-223-3817
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. OTIS LOCKETT JR.
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Credential | MS, LPC, CSAC, LCS
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Telephone | 414-839-8994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5052
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License Number State | WI
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