Provider Demographics
NPI:1922461417
Name:LOCKE WELLNESS CENTER
Entity Type:Organization
Organization Name:LOCKE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN ESPERON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-754-2856
Mailing Address - Street 1:316 E 111TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-3004
Mailing Address - Country:US
Mailing Address - Phone:323-418-1055
Mailing Address - Fax:323-418-3964
Practice Address - Street 1:316 E 111TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-3004
Practice Address - Country:US
Practice Address - Phone:323-418-1055
Practice Address - Fax:323-418-3964
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAUSD SCHOOL MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)