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23D2205052 CLIA NUMBER - GRAND BLANC FIELDS ASSISTED LIV

Laboratory Demographics

CLIA Number: 23D2205052

Facility Name: GRAND BLANC FIELDS ASSISTED LIV

Facility Address:
12628 PAGELS DR
GRAND BLANC, MI
ZIP 48439
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Facility Phone Number: 810 606-0823

Facility Type: Assisted Living Facility

Certificate Type: Waiver
NPI Number: 1649661794

Taxonomy: 103T00000X - Psychologist
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

CLIA Record

Field Name Field Value
CLIA Number 23D2205052
LAB Type Assisted Living Facility
Facility Name GRAND BLANC FIELDS ASSISTED LIV
Street 12628 PAGELS DR
City GRAND BLANC
State MI
ZIP 48439
Phone 810 606-0823
CertificateType 4
CertificateEffectiveDate 12/11/2022
CertificateExpirationDate 12/10/2024
FacilityType Waiver

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