23D2187418 CLIA NUMBER - LIST PSYCHOLOGICAL SERVICES, PLC

Laboratory Demographics

  • CLIA Code: 23D2187418
  • Facility Name: LIST PSYCHOLOGICAL SERVICES, PLC
  • Facility Address: 110 E HURON AVENUE SUITE A
    BAD AXE, MI
    ZIP 48413
  • Facility Phone: 989 975-6696
  • Facility Type: Other - OUTPATIENT SUBSTANCE
  • Facility Type: Waiver
  • Lab Director: JACQUELINE D. LIST
  • NPI Number: 1154894673
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D2187418
LAB Type Other - OUTPATIENT SUBSTANCE
Facility Name LIST PSYCHOLOGICAL SERVICES, PLC
Street 110 E HURON AVENUE SUITE A
City BAD AXE
State MI
ZIP 48413
Phone 989 975-6696
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/1/2024
Certificate Expiration Date 6/30/2026
Facility Type Other - OUTPATIENT SUBSTANCE
Lab Director JACQUELINE D. LIST

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