03D2166688 CLIA NUMBER - PSA BEHAVIORAL HEALTH AGENCY

Laboratory Demographics

  • CLIA Code: 03D2166688
  • Facility Name: PSA BEHAVIORAL HEALTH AGENCY
  • Facility Address: 2255 W NORTHERN AVE
    PHOENIX, AZ
    ZIP 85021
  • Facility Phone: 602 995-1767
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RANDY BRAZIE
  • NPI Number: 1427376003
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 03D2166688
LAB Type Physician Office
Facility Name PSA BEHAVIORAL HEALTH AGENCY
Street 2255 W NORTHERN AVE
City PHOENIX
State AZ
ZIP 85021
Phone 602 995-1767
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/22/2025
Certificate Expiration Date 5/21/2027
Facility Type Physician Office
Lab Director RANDY BRAZIE

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This page was last updated on: 9/29/2025