MEDICARE: L.A. COUNTY DEPT MENTAL HEALTH

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	251S00000X	Community/Behavioral Health Agency	34614	CA

General Provider Information

NPI Number	:	1275886111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L.A. COUNTY DEPT MENTAL HEALTH

Provider Business Mailing Address
First Line	:	467 ARNAZ DR APT 111
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-3950
Country	:	US
Telephone Number	:	480-200-6793
Fax Number	:

Provider Business Practice Location Address
First Line	:	467 ARNAZ DR APT 111
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-3950
Country	:	US
Telephone Number	:	424-249-3873
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCH TECH
Name	:	MARK S MEZA
Credential	:
Telephone Number	:	424-249-3873

Provider Enumeration Date	:	10/16/2012
Last Update Date	:	10/16/2012

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