Organization
MARY LOCKE, PH.D. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY LOCKE PH.D. (PSYCHOLOGIST)
(260) 436-7131
Entity
Organization
Contact information
Practice address
7337 W JEFFERSON BLVD, SUITE 175, FORT WAYNE, IN 46804-6284
(260) 436-7131
(260) 436-5123
Mailing address
7337 W JEFFERSON BLVD, SUITE 175, FORT WAYNE, IN 46804-6284
(260) 436-7131
(260) 436-5123
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040180
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220850
MEDICARE
IN
Enumeration date
10/29/2012
Last updated
10/29/2012
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