15D2218628 CLIA NUMBER - PERSON CENTERED MENTAL WELLNESS, LLC

Laboratory Demographics

CLIA Number: 15D2218628

Facility Name: PERSON CENTERED MENTAL WELLNESS, LLC

Facility Address:
14074 TRADE CENTER DR SUITE 205
FISHERS, IN
ZIP 46038
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Facility Phone Number: 317 779-2947

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1811581879

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D2218628
LAB Type	Practitioner Other
Facility Name	PERSON CENTERED MENTAL WELLNESS, LLC
Street	14074 TRADE CENTER DR SUITE 205
City	FISHERS
State	IN
ZIP	46038
Phone	317 779-2947
CertificateType	4
CertificateEffectiveDate	3/30/2023
CertificateExpirationDate	3/29/2025
FacilityType	Waiver

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