14D2000820 CLIA NUMBER - MATHERS CLINIC LLC

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Laboratory Demographics

CLIA Number: 14D2000820

Facility Name: MATHERS CLINIC LLC

Facility Address:
145 S VIRGINIA ST
CRYSTAL LAKE, IL
ZIP 60014
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Facility Phone Number: 815 397-7654

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1215194519

Taxonomy: 2084P0804X - Psychiatry & Neurology
Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence.

CLIA Record

Field Name	Field Value
CLIA Number	14D2000820
LAB Type	Physician Office
Facility Name	MATHERS CLINIC LLC
Street	145 S VIRGINIA ST
City	CRYSTAL LAKE
State	IL
ZIP	60014
Phone	815 397-7654
CertificateType	4
CertificateEffectiveDate	12/7/2023
CertificateExpirationDate	12/6/2025
FacilityType	Waiver

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