Individual
KENNETH LOCKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
121 W SWEET AVE, UNIVERSITY OF IDAHO - CHILD & YOUTH STUDY CENTER, MOSCOW, ID 83844-4061
(208) 885-6191
(208) 885-6188
Mailing address
121 W SWEET AVE, UNIVERSITY OF IDAHO - CHILD & YOUTH STUDY CENTER, MOSCOW, ID 83844-4061
(208) 885-6191
(208) 885-6188
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-202758
ID
Other
Enumeration date
01/08/2014
Last updated
01/08/2014
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