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General NPI Number Information
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NPI Number | 1356838130
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Entity Type | Organization
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Legal Business Name | JOSEPH LOCKE COUNSELING SERVICES
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 04/20/2018
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Provider Practice Location Address
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Address Line | 909 LINWAY DR STE 5
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City | GOSHEN
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State | IN
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Zip | 46526-2435
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Country | US
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Telephone | 574-370-8095
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Fax |
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Provider Business Mailing Address
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Address Line | 64750 MAXWELLS GATE
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City | GOSHEN
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State | IN
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Zip | 46526-6246
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Country | US
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Telephone | 574-370-8095
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | JOSEPH LOCKE
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Credential | MSW, LCSW
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Telephone | 574-370-8095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34006736A
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License Number State | IN
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