Healthcare Provider Details

I. General information

NPI: 1871507129
Provider Name (Legal Business Name): LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E AVENIDA DE LA MERCED # 103
MONTEBELLO CA
90640-2752
US

IV. Provider business mailing address

510 S VERMONT AVE
LOS ANGELES CA
90020-1992
US

V. Phone/Fax

Practice location:
  • Phone: 323-887-5324
  • Fax: 323-887-5801
Mailing address:
  • Phone: 213-738-4601
  • 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: LISA H. WONG
Title or Position: ACTING DIRECTOR
Credential: PSY.D.
Phone: 213-738-4601