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611 N. Brand Blvd., 3rd And 4th Floor Glendale CA 91203-3286 | |
| (747) 307-2403 | |
| (626) 226-5798 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 611 N. Brand Blvd., 3rd And 4th Floor, Glendale, California |
| Authorized Official Name and Position | Lisa H Wong (DIRECTOR) |
| Authorized Official Contact | 2139476670 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
510 S Vermont Ave Los Angeles CA 90020-1912 Ph: (213) 947-6670 | 611 N. Brand Blvd., 3rd And 4th Floor Glendale CA 91203-3286 Ph: (747) 307-2403 |
| NPI Number | 1396753851 |
|---|---|
| Provider Enumeration Date | 08/03/2006 |
| Last Update Date | 01/15/2025 |
| Certification Date | 01/15/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396753851 | NPI | - | NPPES |
| 7442 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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