Provider Demographics
NPI:1578861910
Name:LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH
Entity type:Organization
Organization Name:LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PSYCHIATRIC SOCIAL WORK
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MA DU BOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-639-6744
Mailing Address - Street 1:1333 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2944
Mailing Address - Country:US
Mailing Address - Phone:562-599-6418
Mailing Address - Fax:
Practice Address - Street 1:1333 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2944
Practice Address - Country:US
Practice Address - Phone:562-599-6418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD1053453251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management