04D2269763 CLIA NUMBER - CHANGES BEHAVIORAL HEALTH LLC

Laboratory Demographics

  • CLIA Code: 04D2269763
  • Facility Name: CHANGES BEHAVIORAL HEALTH LLC
  • Facility Address: 204 MISSISSIPPI ST
    WYNNE, AR
    ZIP 72396
  • Facility Phone: 901 570-0556
  • Facility Type: Other - BEHAVIORAL HEALTH
  • Facility Type: Waiver
  • Lab Director: BRIAN SHAW
  • NPI Number: 1114260486
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 04D2269763
LAB Type Other - BEHAVIORAL HEALTH
Facility Name CHANGES BEHAVIORAL HEALTH LLC
Street 204 MISSISSIPPI ST
City WYNNE
State AR
ZIP 72396
Phone 901 570-0556
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2024
Certificate Expiration Date 10/2/2026
Facility Type Other - BEHAVIORAL HEALTH
Lab Director BRIAN SHAW

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