Organization
LOOKOUT MOUNTAIN COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS FORD PH D (CEO)
(706) 638-5580
Entity
Organization
Contact information
Practice address
501 MIZE ST., LAFAYETTE, GA 30728
(706) 638-5580
(706) 638-5445
Mailing address
501 MIZE ST., LAFAYETTE, GA 30728
(706) 638-5580
(706) 638-5445
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
GA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00604513B
—
GA
05
—
00604513C
—
GA
05
—
00604513D
—
GA
05
—
00604513E
—
GA
05
—
00604513G
—
GA
05
—
00604513H
—
GA
05
—
00604513Z
—
GA
05
—
00810059A
—
GA
05
—
00810059G
—
GA
05
—
0604513U
—
GA
Enumeration date
07/07/2005
Last updated
07/21/2022
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