16D2256550 CLIA NUMBER - MIDWEST MENTAL HEALTH

Laboratory Demographics

CLIA Number: 16D2256550

Facility Name: MIDWEST MENTAL HEALTH

Facility Address:
523 WEST SHERIDAN
SHENANDOAH, IA
ZIP 51601
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Facility Phone Number: 712 246-0159

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1144695040

Taxonomy: 101YM0800X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	16D2256550
LAB Type	Practitioner Other
Facility Name	MIDWEST MENTAL HEALTH
Street	523 WEST SHERIDAN
City	SHENANDOAH
State	IA
ZIP	51601
Phone	712 246-0159
CertificateType	4
CertificateEffectiveDate	3/25/2024
CertificateExpirationDate	3/24/2026
FacilityType	Waiver

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