19D2177078 CLIA NUMBER - LAKE WELLNESS CENTER, LLC - BOUTTE

Laboratory Demographics

  • CLIA Code: 19D2177078
  • Facility Name: LAKE WELLNESS CENTER, LLC - BOUTTE
  • Facility Address: 13371 HIGHWAY 90, SUITE B
    BOUTTE, LA
    ZIP 70039
  • Facility Phone: 888 488-5253
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KELSIE M. GRAHAM
  • NPI Number: 1740824507
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D2177078
LAB Type Physician Office
Facility Name LAKE WELLNESS CENTER, LLC - BOUTTE
Street 13371 HIGHWAY 90, SUITE B
City BOUTTE
State LA
ZIP 70039
Phone 888 488-5253
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/3/2024
Certificate Expiration Date 1/2/2026
Facility Type Physician Office
Lab Director KELSIE M. GRAHAM

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This page was last updated on: 9/29/2025