MEDICARE: KIMBERLY LOCKWOOD LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401015664	MI

General Provider Information

NPI Number	:	1528574290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY LOCKWOOD LPC

Provider Business Mailing Address
First Line	:	1201 N HURON RD
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9458
Country	:	US
Telephone Number	:	517-803-5115
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 N HURON RD
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9458
Country	:	US
Telephone Number	:	517-803-5115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2017
Last Update Date	:	01/26/2022

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Directions to “ KIMBERLY LOCKWOOD LPC” Practice Location

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