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General NPI Number Information
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NPI Number | 1659161958
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Entity Type | Organization
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Legal Business Name | LAC-DMH
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Dates
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Enumeration Date | 05/09/2025
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 4060 WATSON PLAZA DR
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City | LAKEWOOD
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State | CA
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Zip | 90712-4033
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Country | US
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Telephone | 213-905-3659
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Fax |
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Provider Business Mailing Address
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Address Line | 1552 E NORBERRY ST
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City | LANCASTER
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State | CA
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Zip | 93535-3449
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Country | US
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Telephone | 231-905-3659
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Fax |
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Authorized Official
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Title or Position | SR. COMMUNITY WORKER
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Name | MS. CONSTANCE M MANUEL
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Credential |
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Telephone | 213-905-3659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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