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General NPI Number Information
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NPI Number | 1457039273
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH AND SOCIAL JUSTICE CLINIC INC.
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 1700 W CAMERON AVE SUITE 100
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City | WEST COVINA
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State | CA
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Zip | 91790-2718
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Country | US
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Telephone | 213-634-0044
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Fax | 626-388-5990
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Provider Business Mailing Address
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Address Line | 1700 W CAMERON AVE SUITE 100
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City | WEST COVINA
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State | CA
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Zip | 91790-2718
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Country | US
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Telephone | 213-634-0044
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Fax | 626-388-5990
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. ANISSA MCNEIL
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Credential |
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Telephone | 213-634-0044
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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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