10D2188424 CLIA NUMBER - ELITE DNA THERAPY SERVICES LLC

Laboratory Demographics

CLIA Number: 10D2188424

Facility Name: ELITE DNA THERAPY SERVICES LLC

Facility Address:
910 OAKFIELD DR - STE 201A
BRANDON, FL
ZIP 33511
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Facility Phone Number: 239 236-8784

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1063964484

Taxonomy: 103TC0700X - Psychologist
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

CLIA Record

Field Name	Field Value
CLIA Number	10D2188424
LAB Type	Physician Office
Facility Name	ELITE DNA THERAPY SERVICES LLC
Street	910 OAKFIELD DR - STE 201A
City	BRANDON
State	FL
ZIP	33511
Phone	239 236-8784
CertificateType	4
CertificateEffectiveDate	7/16/2022
CertificateExpirationDate	7/15/2024
FacilityType	Waiver

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