Provider Demographics
NPI:1548540875
Name:LOKOTKOV, PETR N (LCSW)
Entity type:Individual
Prefix:MR
First Name:PETR
Middle Name:N
Last Name:LOKOTKOV
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 SAGRADA ST N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-3785
Mailing Address - Country:US
Mailing Address - Phone:503-400-7126
Mailing Address - Fax:
Practice Address - Street 1:161 HIGH ST SE STE 231
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3620
Practice Address - Country:US
Practice Address - Phone:503-400-7126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNO. 0623261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical