13D2274365 CLIA NUMBER - AFFECT THERAPEUTICS INC

Laboratory Demographics

CLIA Number: 13D2274365

Facility Name: AFFECT THERAPEUTICS INC

Facility Address:
1217 E 3RD ST STE 109
NAMPA, ID
ZIP 83651
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Facility Phone Number: 845 769-8758

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1942948351

Taxonomy: 261QM0850X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.

CLIA Record

Field Name	Field Value
CLIA Number	13D2274365
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	AFFECT THERAPEUTICS INC
Street	1217 E 3RD ST STE 109
City	NAMPA
State	ID
ZIP	83651
Phone	845 769-8758
CertificateType	4
CertificateEffectiveDate	1/3/2023
CertificateExpirationDate	1/2/2025
FacilityType	Waiver

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