Healthcare Provider Details

I. General information

NPI: 1164319802
Provider Name (Legal Business Name): LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W LANCASTER BOULEVARD
LANCASTER CA
93534-3107
US

IV. Provider business mailing address

510 S. VERMONT AVE
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 213-407-2611
  • Fax:
Mailing address:
  • Phone: 213-947-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA WONG
Title or Position: DIRECTOR
Credential: PSYCH. D.
Phone: 213-947-6670