Provider Demographics
NPI:1487290177
Name:LA VENTANA PSYCHOLOGY
Entity type:Organization
Organization Name:LA VENTANA PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOOTTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-225-8867
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093-0739
Mailing Address - Country:US
Mailing Address - Phone:505-225-8867
Mailing Address - Fax:
Practice Address - Street 1:209 W MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:LOUISA
Practice Address - State:VA
Practice Address - Zip Code:23093
Practice Address - Country:US
Practice Address - Phone:505-225-8867
Practice Address - Fax:505-933-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty