Basic Information
| Provider Information | |||||||||
| NPI: | 1164771325 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LOS ANGELES DEPARTMENT OF MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2323A EAST PALMDALE BLVD. | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612233813 | ||||||||
| FaxNumber: | 6615372937 | ||||||||
| Practice Location | |||||||||
| Address1: | 2323A EAST PALMDALE BLVD. | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612233813 | ||||||||
| FaxNumber: | 6615372937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2012 | ||||||||
| LastUpdateDate: | 01/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | PERKINS | ||||||||
| AuthorizedOfficialFirstName: | JOELLEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DISTRICT CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 6612233800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | MFC 50920 | CA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | MFC 50920 | 01 | CA | BBS | OTHER |