Provider Demographics
NPI:1164943577
Name:TUDHOPE-LOCKLEAR, LYRIS C (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:LYRIS
Middle Name:C
Last Name:TUDHOPE-LOCKLEAR
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 ARABIAN LN
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-9614
Mailing Address - Country:US
Mailing Address - Phone:360-643-1758
Mailing Address - Fax:
Practice Address - Street 1:211 TAYLOR ST STE 403C
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-5700
Practice Address - Country:US
Practice Address - Phone:360-643-1758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61590440103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical