Provider Demographics
NPI:1902945736
Name:LOCKWOOD, JENNIFER MACHELLE (MA LPCC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MACHELLE
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:MA LPCC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MACHELLE
Other - Last Name:BOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4151
Mailing Address - Country:US
Mailing Address - Phone:505-769-2345
Mailing Address - Fax:505-769-9013
Practice Address - Street 1:300 E 1ST
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88101
Practice Address - Country:US
Practice Address - Phone:505-359-1221
Practice Address - Fax:505-359-1075
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK4174Medicaid