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General NPI Number Information
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NPI Number | 1790008258
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF MENTAL HEALTH, LA COUNTY
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 4067 W 3RD ST APT 106
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City | LOS ANGELES
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State | CA
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Zip | 90020-3168
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Country | US
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Telephone | 213-807-4639
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Fax |
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Provider Business Mailing Address
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Address Line | 4067 W. 3RD ST #106
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City | LOS ANGELES
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State | CA
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Zip | 90020
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Country | US
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Telephone | 213-807-4639
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF MENTAL HEALTH
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Name | DR. MARVIN SOUTHARD
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Credential | DSW
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Telephone | 213-430-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | D05195986
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | MANTELA352PR
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License Number State | WA
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