24D2116385 CLIA NUMBER - CENTRAL MINNESOTA MENTAL HEALTH CENTER

Laboratory Demographics

CLIA Number: 24D2116385

Facility Name: CENTRAL MINNESOTA MENTAL HEALTH CENTER

Facility Address:
1350 14TH STREET NORTH
SAINT CLOUD, MN
ZIP 56303
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Facility Phone Number: 320 230-0532

Facility Type: Other - COMMUNITY MENTAL HEALTH C

Certificate Type: Waiver

NPI Number: 1780890046

Taxonomy: 101YM0800X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	24D2116385
LAB Type	Other - COMMUNITY MENTAL HEALTH C
Facility Name	CENTRAL MINNESOTA MENTAL HEALTH CENTER
Street	1350 14TH STREET NORTH
City	SAINT CLOUD
State	MN
ZIP	56303
Phone	320 230-0532
CertificateType	4
CertificateEffectiveDate	7/26/2022
CertificateExpirationDate	7/25/2024
FacilityType	Waiver

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