Healthcare Provider Details

I. General information

NPI: 1609217173
Provider Name (Legal Business Name): DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 BAUCHET STREET
LOS ANGELES CA
90012
US

IV. Provider business mailing address

1423 HEPNER AVE
LOS ANGELES CA
90041-3107
US

V. Phone/Fax

Practice location:
  • Phone: 213-473-6100
  • Fax:
Mailing address:
  • Phone: 323-809-9553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MONICA LUJAN
Title or Position: PSYCH SW II
Credential: MSW
Phone: 213-473-6100