05D2294308 CLIA NUMBER - LIGHTFULLY BEHAVIOAL HEALTH - CRESCENT

Laboratory Demographics

  • CLIA Code: 05D2294308
  • Facility Name: LIGHTFULLY BEHAVIOAL HEALTH - CRESCENT
  • Facility Address: 2945 TOWNSGATE RD STE #320
    THOUSAND OAKS, CA
    ZIP 91361
  • Facility Phone: 424 477-9547
  • Facility Type: Other - BEHAVIORAL HEALTH RESIDEN
  • Facility Type: Waiver
  • Lab Director: KATHRYN HIRST
  • NPI Number: 1144936311
  • Taxonomy: 261QM0850X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2294308
LAB Type Other - BEHAVIORAL HEALTH RESIDEN
Facility Name LIGHTFULLY BEHAVIOAL HEALTH - CRESCENT
Street 2945 TOWNSGATE RD STE #320
City THOUSAND OAKS
State CA
ZIP 91361
Phone 424 477-9547
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/21/2023
Certificate Expiration Date 11/20/2025
Facility Type Other - BEHAVIORAL HEALTH RESIDEN
Lab Director KATHRYN HIRST

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