Active NPI
Kenneth Locke, PH.D.
- Clinical Psychologist
- Moscow, ID
National Provider Identifier
1659793867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY-202758
- Practice address
- 121 W Sweet Ave
University of Idaho - Child & Youth Study Center
Moscow, ID 83844-4061 - Phone
- (208) 885-6191
- Fax
- (208) 885-6188
- NPI assigned
- Jan 8, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY-202758 | ID | Primary |
Addresses
Primary practice location
121 W Sweet Ave
University of Idaho - Child & Youth Study Center
Moscow, ID 83844-4061
Mailing address
121 W Sweet Ave
University of Idaho - Child & Youth Study Center
Moscow, ID 83844-4061
Phone (208) 885-6191
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-202758 | ID | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents of the University of Idaho Child & Youth Study Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Child & Adolescent Psychologist
- Moscow, ID
- NPI 1609902980
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389139200000",
"number": "1659793867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 W SWEET AVE",
"address_2": "UNIVERSITY OF IDAHO - CHILD & YOUTH STUDY CENTER",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838444061",
"telephone_number": "208-885-6191",
"fax_number": "208-885-6188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 W SWEET AVE",
"address_2": "UNIVERSITY OF IDAHO - CHILD & YOUTH STUDY CENTER",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838444061",
"telephone_number": "208-885-6191",
"fax_number": "208-885-6188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOCKE",
"first_name": "KENNETH",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-01-08",
"last_updated": "2014-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "ID",
"license": "PSY-202758",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moscow, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.