MEDICARE: LDS FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1225233828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LDS FAMILY SERVICES

Provider Business Mailing Address
First Line	:	15501 SAN FERNANDO MISSION BLVD STE 302
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-1359
Country	:	US
Telephone Number	:	818-781-5511
Fax Number	:	818-781-5595

Provider Business Practice Location Address
First Line	:	15501 SAN FERNANDO MISSION BLVD STE 302
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-1359
Country	:	US
Telephone Number	:	818-781-5511
Fax Number	:	818-781-5595

Authorized Official
Title or Position	:	CLINICAL MANAGER
Name	:	MR. ELIZABETH E CHAMBERS
Credential	:
Telephone Number	:	818-781-5511

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	08/11/2014

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