| Jane Pevehouse | |
|
1760 Shinbone Ridge Rd La Fayette GA 30728-4207 | |
| (706) 638-5580 | |
| (706) 638-5445 |
| Full Name | Jane Pevehouse |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1760 Shinbone Ridge Rd, La Fayette, Georgia |
| Authorized Official Name and Position | Tom Ford (CEO) |
| Authorized Official Contact | 7066385580 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jane Pevehouse Po Box 1027 La Fayette GA 30728-1027 Ph: (706) 638-5580 | Jane Pevehouse 1760 Shinbone Ridge Rd La Fayette GA 30728-4207 Ph: (706) 638-5580 |
| NPI Number | 1518297274 |
|---|---|
| Provider Enumeration Date | 12/31/2009 |
| Last Update Date | 12/31/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518297274 | NPI | - | NPPES |
| 000604513DM | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Lookout Mountain Community Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 214 Jones Rd, La Fayette, GA 30728 Phone: 706-638-5580 Fax: 706-638-5445 | |
Lookout Mountain Community Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2448 Corinth Rd, La Fayette, GA 30728 Phone: 706-638-5580 Fax: 706-638-5585 | |
Marcus Logan Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 168 Oak Hill Dr, La Fayette, GA 30728 Phone: 706-638-5580 Fax: 706-638-5445 | |
Lookout Mountain Community Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 Mize St, La Fayette, GA 30728 Phone: 706-638-5580 | |
Linda Dale Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1929 Villanow Mill Creek Rd, La Fayette, GA 30728 Phone: 706-638-5580 Fax: 706-638-5445 | |
Kaye Horne-host Home Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 Mize St, La Fayette, GA 30728 Phone: 706-638-5580 Fax: 706-638-5445 | |
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