Provider Demographics
NPI:1033301221
Name:CHILDREN HOSPITAL LOS ANGELES MENTAL HEALTH
Entity Type:Organization
Organization Name:CHILDREN HOSPITAL LOS ANGELES MENTAL HEALTH
Other - Org Name:CHILDRENS HOSPITAL COMMUNITY MENTAL HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR COMMUNITY MENTAL HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-361-3819
Mailing Address - Street 1:3250 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 320, 500 & 600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1577
Mailing Address - Country:US
Mailing Address - Phone:323-361-3849
Mailing Address - Fax:323-361-7081
Practice Address - Street 1:3250 WILSHIRE BLVD
Practice Address - Street 2:SUITES 320, 500 & 600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1577
Practice Address - Country:US
Practice Address - Phone:323-361-3849
Practice Address - Fax:323-361-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health