01D2133479 CLIA NUMBER - WELLSTONE BEHAVIORAL HEALTH

Laboratory Demographics

CLIA Number: 01D2133479

Facility Name: WELLSTONE BEHAVIORAL HEALTH

Facility Address:
4040 SOUTH MEMORIAL PARKWAY
HUNTSVILLE, AL
ZIP 35802
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Facility Phone Number: 256 533-1970

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1407809213

Taxonomy: 101YM0800X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	01D2133479
LAB Type	Community Clinic
Facility Name	WELLSTONE BEHAVIORAL HEALTH
Street	4040 SOUTH MEMORIAL PARKWAY
City	HUNTSVILLE
State	AL
ZIP	35802
Phone	256 533-1970
CertificateType	4
CertificateEffectiveDate	7/13/2023
CertificateExpirationDate	7/12/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024