Provider Demographics
NPI:1538960422
Name:LOCK, LYDIA MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARIE
Last Name:LOCK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LAKE VIEW RDG
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-5388
Mailing Address - Country:US
Mailing Address - Phone:636-432-8608
Mailing Address - Fax:
Practice Address - Street 1:54 LEGENDS PARKWAY
Practice Address - Street 2:SUITE 157
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025
Practice Address - Country:US
Practice Address - Phone:636-252-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024039264103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst