19D1074431 CLIA NUMBER - MONROE BEHAVIORAL HEALTH CLINIC

Laboratory Demographics

CLIA Number: 19D1074431

Facility Name: MONROE BEHAVIORAL HEALTH CLINIC

Facility Address:
4800 SOUTH GRAND STREET
MONROE, LA
ZIP 71202
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Facility Phone Number: 318 362-5188

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1124772009

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D1074431
LAB Type	Other
Facility Name	MONROE BEHAVIORAL HEALTH CLINIC
Street	4800 SOUTH GRAND STREET
City	MONROE
State	LA
ZIP	71202
Phone	318 362-5188
CertificateType	4
CertificateEffectiveDate	9/27/2023
CertificateExpirationDate	9/26/2025
FacilityType	Waiver

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