Healthcare Provider Details

I. General information

NPI: 1508164328
Provider Name (Legal Business Name): LA COUNTY DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W 155TH ST STE. #103
GARDENA CA
90247-4048
US

IV. Provider business mailing address

1300 W 155TH ST STE. #103
GARDENA CA
90247-4048
US

V. Phone/Fax

Practice location:
  • Phone: 310-512-8100
  • Fax: 310-324-2111
Mailing address:
  • Phone: 310-512-8100
  • Fax: 310-324-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. DON WELLS
Title or Position: PROGRAM HEAD
Credential: LCSW
Phone: 323-241-6730