Provider Demographics
NPI:1174079214
Name:LOCKE, JEFFREY M (LCSW)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:LOCKE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:PROF
Other - First Name:JEFFREY
Other - Middle Name:M
Other - Last Name:LOCKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:500 PECAN DR
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1642
Mailing Address - Country:US
Mailing Address - Phone:317-544-9445
Mailing Address - Fax:
Practice Address - Street 1:7579 N LOOP 1604 W STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249
Practice Address - Country:US
Practice Address - Phone:210-695-1900
Practice Address - Fax:210-695-1901
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX593441041C0700X
IN34007608A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical