21D2328594 CLIA NUMBER - KELLEEN BECK - THE MAMA COACH

Laboratory Demographics

  • CLIA Code: 21D2328594
  • Facility Name: KELLEEN BECK - THE MAMA COACH
  • Facility Address: 12209 FALLEN TIMBERS CIRCLE
    HAGERSTOWN, MD
    ZIP 21740
  • Facility Phone: 240 678-2590
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: KELLEEN BECK
  • NPI Number: 1922705938
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 21D2328594
LAB Type Practitioner Other
Facility Name KELLEEN BECK - THE MAMA COACH
Street 12209 FALLEN TIMBERS CIRCLE
City HAGERSTOWN
State MD
ZIP 21740
Phone 240 678-2590
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/13/2025
Certificate Expiration Date 8/12/2027
Facility Type Practitioner Other
Lab Director KELLEEN BECK

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