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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811266901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH

Provider Business Mailing Address
First Line	:	510 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1992
Country	:	US
Telephone Number	:	213-947-6670
Fax Number	:

Provider Business Practice Location Address
First Line	:	6330 RUGBY AVENUE
Second Line	:	2ND FLOOR STE 200
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4066
Country	:	US
Telephone Number	:	213-947-6722
Fax Number	:	213-487-0764

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. LISA H. WONG
Credential	:	PSY.D.
Telephone Number	:	213-947-6670

Provider Enumeration Date	:	12/20/2011
Last Update Date	:	10/03/2023

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

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