Look up the most recent NPI and PECOS records

Jacob Weatherholtz

Counselor

Behavioral Health & Social Service Providers

3300 Rivermont Ave, Lynchburg, VA 24503-2030

PECOS Enrollment

Based on the most recent information from CMS, provider Jacob Weatherholtz is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 34 days ago.

Profile Details

Provider ID
1447092796
Provider Type
Individual
Full Name
Weatherholtz, Jacob
Credential
LPC, CAADC

Gender
Male
Sole Proprietor
No
Enumeration Date
6/8/2024
Last Updated
6/8/2024

Contact Information

Practice Location

3300 Rivermont Ave, Lynchburg, VA 24503-2030

(434) 200-6532

Unlisted Fax

Mailing Location

542 Leesville Rd Apt 115, Lynchburg, VA 24502-2351

(434) 200-6532

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YP2500X Primary	Description Counselor Behavioral Health & Social Service Providers	License 0701013608 Virginia

Jacob Weatherholtz

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Sova, Patricia

Blevins, Elizabeth S

Brooks, Jeanne D

Blackwell, Mary Clayton

Eager, Benjamin

Declet Rodriguez, Guadalupe

Waters, Tiffany Patricia

Davis, Bryn

Johnson, Stephen George

Demato, Doris