| Mary Kathleen West Lcsw, Inc | |
|
201 Cove Rd Jasper GA 30143 | |
| (706) 253-9515 | |
| (706) 253-9516 |
| Full Name | Mary Kathleen West Lcsw, Inc |
|---|---|
| Speciality | Social Worker |
| Location | 201 Cove Rd, Jasper, Georgia |
| Authorized Official Name and Position | Mary Kathleen West (OWNER) |
| Authorized Official Contact | 7062539515 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Kathleen West Lcsw, Inc 201 Cove Rd Jasper GA 30143 Ph: (706) 253-9515 | Mary Kathleen West Lcsw, Inc 201 Cove Rd Jasper GA 30143 Ph: (706) 253-9515 |
| NPI Number | 1447586268 |
|---|---|
| Provider Enumeration Date | 10/29/2009 |
| Last Update Date | 10/09/2020 |
| Certification Date | 10/09/2020 |
| Medicare PECOS PAC ID | 6901069731 |
|---|---|
| Medicare Enrollment ID | O20120515000363 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447586268 | NPI | - | NPPES |
| 939149656A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW1362 (Georgia) | Primary |
| Provider Name | Mary Kathleen West |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134193741 PECOS PAC ID: 1759544596 Enrollment ID: I20120515000425 |
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