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General NPI Number Information
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NPI Number | 1750452181
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Entity Type | Organization
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Legal Business Name | COMPTON MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 921 E COMPTON BLVD
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City | COMPTON
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State | CA
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Zip | 90221-3303
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Country | US
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Telephone | 310-668-6862
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Fax |
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Provider Business Mailing Address
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Address Line | 3811 EDGEHILL DR
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City | LOS ANGELES
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State | CA
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Zip | 90008-1932
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Country | US
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Telephone | 323-291-7275
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR RN
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Name | MRS. VIVIAN B. WATTS
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Credential | REGISTERED NURSE
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Telephone | 310-668-6862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 163WP0808X
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License Number State | CA
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