23D2040951 CLIA NUMBER - TEAM MENTAL HEALTH SERVICES

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Laboratory Demographics

CLIA Number: 23D2040951

Facility Name: TEAM MENTAL HEALTH SERVICES

Facility Address:
14799 DIX TOLEDO
SOUTHGATE, MI
ZIP 48195
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Facility Phone Number: 734 324-8326

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295324291

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D2040951
LAB Type	Physician Office
Facility Name	TEAM MENTAL HEALTH SERVICES
Street	14799 DIX TOLEDO
City	SOUTHGATE
State	MI
ZIP	48195
Phone	734 324-8326
CertificateType	4
CertificateEffectiveDate	5/15/2022
CertificateExpirationDate	5/14/2024
FacilityType	Waiver

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