Provider Demographics
NPI:1285296749
Name:LOCK, MARIBELLE (LPC)
Entity type:Individual
Prefix:
First Name:MARIBELLE
Middle Name:
Last Name:LOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4101
Mailing Address - Country:US
Mailing Address - Phone:956-507-0377
Mailing Address - Fax:956-922-1090
Practice Address - Street 1:2390 CENTRAL BLVD STE G
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8717
Practice Address - Country:US
Practice Address - Phone:956-507-0377
Practice Address - Fax:956-992-1090
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77553101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX399487303Medicaid