Provider Demographics
NPI:1659161958
Name:LAC-DMH
Entity type:Organization
Organization Name:LAC-DMH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. COMMUNITY WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-905-3659
Mailing Address - Street 1:1552 E NORBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-3449
Mailing Address - Country:US
Mailing Address - Phone:231-905-3659
Mailing Address - Fax:
Practice Address - Street 1:4060 WATSON PLAZA DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-4033
Practice Address - Country:US
Practice Address - Phone:213-905-3659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health