Individual
MS. LAURIE BENOLD LOCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LPC
Contact information
Practice address
404 W 9TH STREET, SUITE 104, GEORGETOWN, TX 78626
(512) 868-0066
Mailing address
404 W 9TH STREET, SUITE 104, GEORGETOWN, TX 78626
(512) 868-0066
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
17951
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1698615Q1
—
TX
Enumeration date
09/01/2006
Last updated
07/08/2007
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