Provider Demographics
NPI:1851677355
Name:LAUSD SCHOOL MENTAL HEALTH
Entity Type:Organization
Organization Name:LAUSD SCHOOL MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM FACILITATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KEZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-997-2640
Mailing Address - Street 1:6651 BALBOA BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5529
Mailing Address - Country:US
Mailing Address - Phone:818-997-2640
Mailing Address - Fax:818-996-9850
Practice Address - Street 1:6651 BALBOA AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406
Practice Address - Country:US
Practice Address - Phone:818-997-2640
Practice Address - Fax:818-996-9850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOS ANGELES UNIFIED SCHOOL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 11953251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)