MEDICARE: LOS ANGELES COUNTY DEPARTMENT OF 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	7756	CA

General Provider Information

NPI Number	:	1477989515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH

Provider Business Mailing Address
First Line	:	550 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1912
Country	:	US
Telephone Number	:	213-738-4601
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 E AVENUE K6 STE H
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93535-4513
Country	:	US
Telephone Number	:	661-947-8400
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MARVIN J SOUTHARD
Credential	:	D.S.W.
Telephone Number	:	213-738-4601

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	09/20/2013

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Directions to “LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH ” Practice Location

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