Provider Demographics
NPI:1386715589
Name:LOS ANGELES COUNTY DEPT. OF MENTAL HEALTH
Entity type:Organization
Organization Name:LOS ANGELES COUNTY DEPT. OF MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MENTAL HEALTH COUNSELOR RN
Authorized Official - Prefix:MISS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:ONEAL
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:800-854-7771
Mailing Address - Street 1:12440 IMPERIAL HWY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3177
Mailing Address - Country:US
Mailing Address - Phone:800-854-7771
Mailing Address - Fax:
Practice Address - Street 1:12440 IMPERIAL HWY
Practice Address - Street 2:SUITE 116
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3177
Practice Address - Country:US
Practice Address - Phone:800-854-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122033251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health