Provider Demographics
NPI:1730541160
Name:LOCKWOOD, MORGON
Entity type:Individual
Prefix:
First Name:MORGON
Middle Name:
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 BAKER STREET
Mailing Address - Street 2:
Mailing Address - City:ST.MICHAEL
Mailing Address - State:AK
Mailing Address - Zip Code:99659
Mailing Address - Country:US
Mailing Address - Phone:907-923-3311
Mailing Address - Fax:907-923-2287
Practice Address - Street 1:94 BAKER STREET
Practice Address - Street 2:
Practice Address - City:ST.MICHAEL
Practice Address - State:AK
Practice Address - Zip Code:99659-0094
Practice Address - Country:US
Practice Address - Phone:907-923-3311
Practice Address - Fax:907-923-2287
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHAOtherCHA