Provider Demographics
NPI:1205661394
Name:LOS ANGELES MENTAL HEALTH WELLNESS CENTER
Entity type:Organization
Organization Name:LOS ANGELES MENTAL HEALTH WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TALIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SISLYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-800-9702
Mailing Address - Street 1:1716 W BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1313
Mailing Address - Country:US
Mailing Address - Phone:818-800-9702
Mailing Address - Fax:
Practice Address - Street 1:1716 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1313
Practice Address - Country:US
Practice Address - Phone:818-800-9702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health