Provider Demographics
NPI:1215124623
Name:LOCKHART, JEFFREY LYLE (LMFT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LYLE
Last Name:LOCKHART
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W ALONA LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-2202
Mailing Address - Country:US
Mailing Address - Phone:608-723-6357
Mailing Address - Fax:608-723-4417
Practice Address - Street 1:200 W ALONA LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-2202
Practice Address - Country:US
Practice Address - Phone:608-723-6357
Practice Address - Fax:608-723-4417
Is Sole Proprietor?:No
Enumeration Date:2007-09-29
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI770-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist