06D2265433 CLIA NUMBER - PEDIATRIC & FAMILY PSYCHIATRY, LLC

Laboratory Demographics

CLIA Number: 06D2265433

Facility Name: PEDIATRIC & FAMILY PSYCHIATRY, LLC

Facility Address:
4760 FLINTRIDGE DR, SUITE 220-O
COLORADO SPRINGS, CO
ZIP 80918
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Facility Phone Number: 719 407-3312

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1174256465

Taxonomy: 363LP0808X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	06D2265433
LAB Type	Physician Office
Facility Name	PEDIATRIC & FAMILY PSYCHIATRY, LLC
Street	4760 FLINTRIDGE DR, SUITE 220-O
City	COLORADO SPRINGS
State	CO
ZIP	80918
Phone	719 407-3312
CertificateType	4
CertificateEffectiveDate	7/27/2022
CertificateExpirationDate	7/26/2024
FacilityType	Waiver

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