| Lookout Mountain Community Services | |
|
501 Mize St. Lafayette GA 30728 | |
| (706) 638-5580 | |
| (706) 638-5445 |
| Full Name | Lookout Mountain Community Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 501 Mize St., Lafayette, Georgia |
| Authorized Official Name and Position | Thomas Ford (CEO) |
| Authorized Official Contact | 7066385580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lookout Mountain Community Services 501 Mize St. Lafayette GA 30728 Ph: (706) 638-5580 | Lookout Mountain Community Services 501 Mize St. Lafayette GA 30728 Ph: (706) 638-5580 |
| NPI Number | 1790782431 |
|---|---|
| Provider Enumeration Date | 07/07/2005 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 4880682822 |
|---|---|
| Medicare Enrollment ID | O20040506000251 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790782431 | NPI | - | NPPES |
| 00604513E | Medicaid | GA | |
| 00604513G | Medicaid | GA | |
| 0604513U | Medicaid | GA | |
| 00604513H | Medicaid | GA | |
| 00604513Z | Medicaid | GA | |
| 00604513C | Medicaid | GA | |
| 00810059A | Medicaid | GA | |
| 00604513B | Medicaid | GA | |
| 00604513D | Medicaid | GA | |
| 00810059G | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Georgia) | Primary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Secondary |
| Provider Name | William F Shivers |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457420614 PECOS PAC ID: 9931196920 Enrollment ID: I20040430000091 |
| Provider Name | Madhubala A Patel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699847616 PECOS PAC ID: 3173692548 Enrollment ID: I20080527000649 |
| Provider Name | Michael W Free |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942324025 PECOS PAC ID: 8527138932 Enrollment ID: I20080528000206 |
| Provider Name | Satishchandra B Patel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841224581 PECOS PAC ID: 7416026810 Enrollment ID: I20080528000392 |
| Provider Name | Marlene Zetzer Shivers |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801915871 PECOS PAC ID: 9931267861 Enrollment ID: I20081022000305 |
| Provider Name | Estaban L Lim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235238775 PECOS PAC ID: 5092873604 Enrollment ID: I20081027000571 |
| Provider Name | Marion E Alston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801166749 PECOS PAC ID: 2567623481 Enrollment ID: I20120419000456 |
| Provider Name | Ronal E Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275699910 PECOS PAC ID: 6507945797 Enrollment ID: I20120912000338 |
| Provider Name | Dana Morgan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043761331 PECOS PAC ID: 5597047522 Enrollment ID: I20170126001111 |
| Provider Name | Karen E Brazell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689035032 PECOS PAC ID: 4789958364 Enrollment ID: I20170920002110 |
| Provider Name | Kimberly J Butler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598110843 PECOS PAC ID: 6406111699 Enrollment ID: I20180516002924 |
| Provider Name | Angela K Llewellyn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154801454 PECOS PAC ID: 6608120001 Enrollment ID: I20200124000834 |
| Provider Name | Safinaz Mostafa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386027696 PECOS PAC ID: 6608167200 Enrollment ID: I20200423003301 |
| Provider Name | Sarah A Rhomberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083923791 PECOS PAC ID: 7416182191 Enrollment ID: I20201203001749 |
| Provider Name | David C Morton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013978204 PECOS PAC ID: 9537571492 Enrollment ID: I20201217000699 |
| Provider Name | Jamie Lee Sorenson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457619603 PECOS PAC ID: 3971885385 Enrollment ID: I20210407001577 |
| Provider Name | Jamie Lee Satterfield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710540133 PECOS PAC ID: 4880069277 Enrollment ID: I20230418000365 |
| Provider Name | Shaleena Lynn Walden |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1023722873 PECOS PAC ID: 9234588732 Enrollment ID: I20231208002964 |
| Provider Name | Emily Webb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518749522 PECOS PAC ID: 8426407305 Enrollment ID: I20231218003083 |
| Provider Name | Stacey Page |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861941668 PECOS PAC ID: 5294186508 Enrollment ID: I20240123001116 |
| Provider Name | Heather Roesner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588780357 PECOS PAC ID: 5698169548 Enrollment ID: I20240201000823 |
| Provider Name | Gregory H Sadler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053540930 PECOS PAC ID: 1355784661 Enrollment ID: I20240205001602 |
| Provider Name | John William Landrum |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1619093564 PECOS PAC ID: 4183067044 Enrollment ID: I20240207002227 |
| Provider Name | Lisa Michelle Stephans |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649700212 PECOS PAC ID: 7315380219 Enrollment ID: I20240207003932 |
| Provider Name | Steven Mitchell Scott |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831375690 PECOS PAC ID: 3577907849 Enrollment ID: I20240215000888 |
| Provider Name | Barry Kevin Godfrey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609017433 PECOS PAC ID: 0042654113 Enrollment ID: I20240216000434 |
| Provider Name | Heather Dockery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760253280 PECOS PAC ID: 0042655268 Enrollment ID: I20240228000158 |
| Provider Name | Kelley Ann Mccahill |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043657190 PECOS PAC ID: 2567807209 Enrollment ID: I20240304002089 |
| Provider Name | Shana L Stokes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912373309 PECOS PAC ID: 6204277296 Enrollment ID: I20240508001218 |
| Provider Name | Rose M Casey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154177566 PECOS PAC ID: 8820439656 Enrollment ID: I20240510002714 |
Lookout Mountain Community Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1218 Chattanooga St., Lafayette, 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., Lafayette, GA 30728 Phone: 706-638-5591 Fax: 706-639-2055 | |
Lookout Mountain Community Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 43 Shady Court, Lafayette, GA 30728 Phone: 706-638-5580 Fax: 706-638-5585 | |
Lookout Mountain Community Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 29 Mae Tucker Rd., Lafayette, GA 30728 Phone: 423-903-0236 | |
Lookout Mountain Community Service Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 322 New Hope Road, Lafayette, GA 30728 Phone: 706-764-1942 |