Provider Demographics
NPI:1902065626
Name:LOCKE, TIMOTHY B (PHD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:B
Last Name:LOCKE
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 1:1834 1ST ST
Mailing Address - Street 2:STE. 2
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2353
Mailing Address - Country:US
Mailing Address - Phone:707-927-4488
Mailing Address - Fax:
Practice Address - Street 1:1834 1ST ST
Practice Address - Street 2:STE. 2
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2353
Practice Address - Country:US
Practice Address - Phone:707-927-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral