Provider Demographics
NPI:1174860662
Name:MHCDI, LLC
Entity Type:Organization
Organization Name:MHCDI, LLC
Other - Org Name:MENTAL HEALTH COMMUNITY DEVELOPMENT INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-288-3460
Mailing Address - Street 1:600 W BROADWAY STE 315
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1025
Mailing Address - Country:US
Mailing Address - Phone:818-288-3460
Mailing Address - Fax:866-912-7569
Practice Address - Street 1:600 W BROADWAY STE 315
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1025
Practice Address - Country:US
Practice Address - Phone:818-288-3460
Practice Address - Fax:866-912-7569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency