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General NPI Number Information
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NPI Number | 1407571367
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Entity Type | Organization
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Legal Business Name | LIVING CONNECTED MBS, INC.
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 14311 GRAYVILLE DR
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City | LA MIRADA
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State | CA
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Zip | 90638-1931
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Country | US
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Telephone | 626-360-0828
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Fax |
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Provider Business Mailing Address
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Address Line | 14901 ADELFA DR UNIT 1675
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City | LA MIRADA
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State | CA
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Zip | 90638-4749
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Country | US
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Telephone | 626-360-0828
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. TINA ROSE HOUSTON-ARMSTRONG
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Credential | PH.D.
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Telephone | 626-360-0828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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