Provider Demographics
NPI:1386748796
Name:LOCKWOOD PSYCHOLOGICAL SERVICES LTD
Entity type:Organization
Organization Name:LOCKWOOD PSYCHOLOGICAL SERVICES LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-754-1488
Mailing Address - Street 1:453 COVENTRY LN
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7504
Mailing Address - Country:US
Mailing Address - Phone:847-754-1488
Mailing Address - Fax:815-356-1488
Practice Address - Street 1:453 COVENTRY LN
Practice Address - Street 2:SUITE 103A
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7504
Practice Address - Country:US
Practice Address - Phone:847-754-1488
Practice Address - Fax:815-356-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006634103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212802Medicare ID - Type Unspecified