MEDICARE: COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477567014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH

Provider Business Mailing Address
First Line	:	510 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1992
Country	:	US
Telephone Number	:	213-738-4601
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 W TEMPLE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-3208
Country	:	US
Telephone Number	:	213-974-0502
Fax Number	:

Authorized Official
Title or Position	:	ACTING DIRECTOR
Name	:	LISA H. WONG
Credential	:	PSY.D.
Telephone Number	:	213-738-4601

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/18/2022

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Directions to “COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH ” Practice Location

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