Basic Information
| Provider Information | |||||||||
| NPI: | 1538889829 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 S VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900201992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2137384601 | ||||||||
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| Practice Location | |||||||||
| Address1: | 349 E AVENUE K6 STE A | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935354548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617234260 | ||||||||
| FaxNumber: | 6617236975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2022 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | WONG | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | ACTING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2137384601 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.