Basic Information
| Provider Information | |||||||||
| NPI: | 1386715589 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOS ANGELES COUNTY DEPT. OF MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12440 IMPERIAL HWY | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906503177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008547771 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12440 IMPERIAL HWY | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906503177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008547771 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JACKSON | ||||||||
| AuthorizedOfficialFirstName: | GLORIA | ||||||||
| AuthorizedOfficialMiddleName: | ONEAL | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR MENTAL HEALTH COUNSELOR RN | ||||||||
| AuthorizedOfficialTelephone: | 8008547771 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | REGISTERED NURSE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 122033 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.