Provider Demographics
NPI:1245583327
Name:GEORGE J MEZA LICENSED CLINICAL SOCIAL WORKERS INC.
Entity Type:Organization
Organization Name:GEORGE J MEZA LICENSED CLINICAL SOCIAL WORKERS INC.
Other - Org Name:MEZA MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JESUS
Authorized Official - Last Name:MEZA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:310-978-9495
Mailing Address - Street 1:15212 ROSELLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2308
Mailing Address - Country:US
Mailing Address - Phone:310-978-9495
Mailing Address - Fax:310-978-0978
Practice Address - Street 1:15212 ROSELLE AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2308
Practice Address - Country:US
Practice Address - Phone:310-978-9495
Practice Address - Fax:310-978-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS16305251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health