Provider Demographics
NPI:1356120240
Name:MAAT
Entity type:Organization
Organization Name:MAAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LENFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-388-2611
Mailing Address - Street 1:6230 WILSHIRE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5126
Mailing Address - Country:US
Mailing Address - Phone:310-388-2611
Mailing Address - Fax:
Practice Address - Street 1:3500 W MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2164
Practice Address - Country:US
Practice Address - Phone:323-855-7527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No347D00000XTransportation ServicesTrain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598121667Medicaid