23D2070368 CLIA NUMBER - WELL SPRING PSYCHIATRY PC

Laboratory Demographics

  • CLIA Code: 23D2070368
  • Facility Name: WELL SPRING PSYCHIATRY PC
  • Facility Address: 1305 E EIGHTH STREET SUITE B
    TRAVERSE CITY, MI
    ZIP 49684
  • Facility Phone: 231 922-9625
  • Facility Type: Other - OUTPT PSYCH OFFICE
  • Facility Type: Waiver
  • Lab Director: MARILYN E. CONLON
  • NPI Number: 1922112077
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 23D2070368
LAB Type Other - OUTPT PSYCH OFFICE
Facility Name WELL SPRING PSYCHIATRY PC
Street 1305 E EIGHTH STREET SUITE B
City TRAVERSE CITY
State MI
ZIP 49684
Phone 231 922-9625
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2023
Certificate Expiration Date 12/12/2025
Facility Type Other - OUTPT PSYCH OFFICE
Lab Director MARILYN E. CONLON

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