Basic Information
| Provider Information | |||||||||
| NPI: | 1477989515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 S VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900201912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2137384601 | ||||||||
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| Practice Location | |||||||||
| Address1: | 251 E AVENUE K6 STE H | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935354513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619478400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2013 | ||||||||
| LastUpdateDate: | 09/20/2013 | ||||||||
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| AuthorizedOfficialLastName: | SOUTHARD | ||||||||
| AuthorizedOfficialFirstName: | MARVIN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2137384601 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.S.W. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 7756 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.