Provider Demographics
NPI:1902926413
Name:LAUSD 97TH ST VALLEYSMH
Entity type:Organization
Organization Name:LAUSD 97TH ST VALLEYSMH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-754-2856
Mailing Address - Street 1:439 W 97TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-3968
Mailing Address - Country:US
Mailing Address - Phone:323-754-2856
Mailing Address - Fax:
Practice Address - Street 1:439 W 97TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-3968
Practice Address - Country:US
Practice Address - Phone:323-754-2856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS15936251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)