Provider Demographics
NPI:1588742720
Name:LOCKHART, JOSEPH JEROME (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JEROME
Last Name:LOCKHART
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 N H ST
Mailing Address - Street 2:NO. 117
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-8138
Mailing Address - Country:US
Mailing Address - Phone:805-737-6632
Mailing Address - Fax:
Practice Address - Street 1:1305 N H ST
Practice Address - Street 2:NO. 117
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-8138
Practice Address - Country:US
Practice Address - Phone:805-737-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12686103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical