| Mary Locke, Ph.d. Llc | |
|
7337 W Jefferson Blvd Suite 175 Fort Wayne IN 46804-6284 | |
| (260) 436-7131 | |
| (260) 436-5123 |
| Full Name | Mary Locke, Ph.d. Llc |
|---|---|
| Speciality | Psychologist |
| Location | 7337 W Jefferson Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Mary Locke (PSYCHOLOGIST) |
| Authorized Official Contact | 2604367131 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Locke, Ph.d. Llc 7337 W Jefferson Blvd Suite 175 Fort Wayne IN 46804-6284 Ph: (260) 436-7131 | Mary Locke, Ph.d. Llc 7337 W Jefferson Blvd Suite 175 Fort Wayne IN 46804-6284 Ph: (260) 436-7131 |
| NPI Number | 1548514656 |
|---|---|
| Provider Enumeration Date | 10/29/2012 |
| Last Update Date | 10/29/2012 |
| Medicare PECOS PAC ID | 0345492948 |
|---|---|
| Medicare Enrollment ID | O20121205000506 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548514656 | NPI | - | NPPES |
| 220850 | Other | IN | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 20040180 (Indiana) | Primary |
| Provider Name | Mary L Shear |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1144213711 PECOS PAC ID: 5496718488 Enrollment ID: I20041110000778 |
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