Provider Demographics
NPI:1477834125
Name:LAC EMERGENCY OUTREACH BUREAU (PSYCHIATRIC MOBILE RESPONSE TEAM)
Entity Type:Organization
Organization Name:LAC EMERGENCY OUTREACH BUREAU (PSYCHIATRIC MOBILE RESPONSE TEAM)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JOELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIESTAD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-534-1083
Mailing Address - Street 1:11715 PATTON RD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11715 PATTON RD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5234
Practice Address - Country:US
Practice Address - Phone:562-644-8662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)