Provider Demographics
NPI:1508164328
Name:LA COUNTY DEPARTMENT OF MENTAL HEALTH
Entity Type:Organization
Organization Name:LA COUNTY DEPARTMENT OF MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM HEAD
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-241-6730
Mailing Address - Street 1:1300 W 155TH ST
Mailing Address - Street 2:STE. #103
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4048
Mailing Address - Country:US
Mailing Address - Phone:310-512-8100
Mailing Address - Fax:310-324-2111
Practice Address - Street 1:1300 W 155TH ST
Practice Address - Street 2:STE. #103
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4048
Practice Address - Country:US
Practice Address - Phone:310-512-8100
Practice Address - Fax:310-324-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty