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General NPI Number Information
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NPI Number | 1659441368
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Entity Type | Organization
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Legal Business Name | LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 06/15/2008
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Provider Practice Location Address
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Address Line | 2311 W EL SEGUNDO BLVD
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City | HAWTHORNE
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State | CA
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Zip | 90250-3315
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Country | US
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Telephone | 323-241-6730
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Fax | 323-756-1163
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Provider Business Mailing Address
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Address Line | 233 WAPELLO ST
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City | ALTADENA
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State | CA
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Zip | 91001-4442
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Country | US
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Telephone | 626-398-0116
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MARVIN J SOUTHARD
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Credential | D.S.W.
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Telephone | 213-738-4601
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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 | 334162
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License Number State | CA
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