Organization
MAAT
Active
Other names
Gravity Wellnes
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANCE R LENFORD PSY.D (CLINICAL PSYCHOLOGIST)
(310) 388-2611
Entity
Organization
Contact information
Practice address
3500 W MANCHESTER BLVD, INGLEWOOD, CA 90305-2164
(323) 855-7527
Mailing address
6230 WILSHIRE BLVD STE A, LOS ANGELES, CA 90048-5126
(310) 388-2611
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
347D00000X
Train
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598121667
—
CA
Enumeration date
09/28/2023
Last updated
09/28/2023
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