| Dmh Dhs Collaboration Mlk Opc | |
|
1670 E 120th St Room # 2e02, 2e06 Los Angeles CA 90059-3026 | |
| (213) 738-3111 | |
| (213) 386-5282 |
| Full Name | Dmh Dhs Collaboration Mlk Opc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1670 E 120th St, Los Angeles, California |
| Authorized Official Name and Position | Lisa H. Wong (ACTING DIRECTOR) |
| Authorized Official Contact | 2137384601 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dmh Dhs Collaboration Mlk Opc 510 S Vermont Ave Los Angeles CA 90020-1992 Ph: (213) 738-4601 | Dmh Dhs Collaboration Mlk Opc 1670 E 120th St Room # 2e02, 2e06 Los Angeles CA 90059-3026 Ph: (213) 738-3111 |
| NPI Number | 1982952693 |
|---|---|
| Provider Enumeration Date | 08/28/2012 |
| Last Update Date | 08/18/2022 |
| Certification Date | 08/18/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982952693 | NPI | - | NPPES |
| 7841 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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