| La Ventana Psychology | |
|
102 Elm Ave Louisa VA 23093 | |
| (505) 225-8867 | |
| (505) 933-7530 |
| Full Name | La Ventana Psychology |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 102 Elm Ave, Louisa, Virginia |
| Authorized Official Name and Position | Jane M Wootton (SOLE OWNER) |
| Authorized Official Contact | 5052258867 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| La Ventana Psychology Po Box 739 Louisa VA 23093-0739 Ph: (505) 225-8867 | La Ventana Psychology 102 Elm Ave Louisa VA 23093 Ph: (505) 225-8867 |
| NPI Number | 1487290177 |
|---|---|
| Provider Enumeration Date | 11/18/2019 |
| Last Update Date | 11/25/2022 |
| Certification Date | 11/18/2022 |
| Medicare PECOS PAC ID | 8820424708 |
|---|---|
| Medicare Enrollment ID | O20200213000388 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487290177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Jane M Wootton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639393143 PECOS PAC ID: 3678745767 Enrollment ID: I20141119001257 |
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