Provider Demographics
NPI:1295016798
Name:SAN FERNANDO COMMUNITY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:SAN FERNANDO COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-374-6901
Mailing Address - Street 1:6842 VAN NUYS BLVD FL 6
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6842 VAN NUYS BLVD FL 6
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4653
Practice Address - Country:US
Practice Address - Phone:818-374-6901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health