| Lockett Enterprises, Llc | |
|
230 W Wells St Suite 214 Milwaukee WI 53203-1866 | |
| (414) 839-8994 | |
| (414) 223-3817 |
| Full Name | Lockett Enterprises, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 230 W Wells St, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Otis Lockett (PRESIDENT) |
| Authorized Official Contact | 4148398994 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lockett Enterprises, Llc 230 W Wells St Suite 214 Milwaukee WI 53203-1866 Ph: (414) 839-8994 | Lockett Enterprises, Llc 230 W Wells St Suite 214 Milwaukee WI 53203-1866 Ph: (414) 839-8994 |
| NPI Number | 1174927743 |
|---|---|
| Provider Enumeration Date | 10/10/2014 |
| Last Update Date | 05/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174927743 | NPI | - | NPPES |
| 39394200 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 5052 (Wisconsin) | Primary |
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