MEDICARE: JANE HORTMAN MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	APC006494	GA
2	101YP2500X	Professional Counselor	LPC012297	GA

General Provider Information

NPI Number	:	1639653298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE HORTMAN MA, LPC

Provider Business Mailing Address
First Line	:	104 W 6TH AVE STE 100
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-3050
Country	:	US
Telephone Number	:	706-250-1634
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 W 6TH AVE STE 100
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-3050
Country	:	US
Telephone Number	:	706-250-1634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2018
Last Update Date	:	01/31/2022

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Directions to “ JANE HORTMAN MA, LPC” Practice Location

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