| Ese Mental Health Llc | |
|
1539 Old Valdosta Rd Ray City GA 31645-7132 | |
| (706) 480-4322 | |
| Not Available |
| Full Name | Ese Mental Health Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1539 Old Valdosta Rd, Ray City, Georgia |
| Authorized Official Name and Position | Wendy Pearson (OWNER) |
| Authorized Official Contact | 2293561360 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ese Mental Health Llc 1539 Old Valdosta Rd Ray City GA 31645-7132 Ph: (877) 755-2212 | Ese Mental Health Llc 1539 Old Valdosta Rd Ray City GA 31645-7132 Ph: (706) 480-4322 |
| NPI Number | 1659094704 |
|---|---|
| Provider Enumeration Date | 09/23/2022 |
| Last Update Date | 07/17/2023 |
| Certification Date | 07/17/2023 |
| Medicare PECOS PAC ID | 2961879796 |
|---|---|
| Medicare Enrollment ID | O20221107002867 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659094704 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| Provider Name | Sarah P Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962907121 PECOS PAC ID: 3678825189 Enrollment ID: I20181011000911 |
| Provider Name | Erin Harrell Ray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801141429 PECOS PAC ID: 4284031113 Enrollment ID: I20221115000609 |
| Provider Name | Octavia Faulk |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992110597 PECOS PAC ID: 6800254368 Enrollment ID: I20230621000377 |