03D2141196 CLIA NUMBER - LIFELINE PROFESSIONAL COUNSELING SERVICES

Laboratory Demographics

CLIA Number: 03D2141196

Facility Name: LIFELINE PROFESSIONAL COUNSELING SERVICES

Facility Address:
17215 N 72ND DR, SUITE C-125
GLENDALE, AZ
ZIP 85308
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Facility Phone Number: (480) 641-1165

Facility Type: OTHER

Certificate Type: Waiver

NPI Number: 1720580038

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2141196
LAB Type	OTHER
Facility Name	LIFELINE PROFESSIONAL COUNSELING SERVICES
Street	17215 N 72ND DR, SUITE C-125
City	GLENDALE
State	AZ
ZIP	85308
Phone	(480) 641-1165

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This page was last updated on: 5/11/2023