24D2274336 CLIA NUMBER - ANOKA COUNTY JUVENILE CENTER

Laboratory Demographics

CLIA Number: 24D2274336

Facility Name: ANOKA COUNTY JUVENILE CENTER

Facility Address:
7555 4TH AVENUE
LINO LAKES, MN
ZIP 55014
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Facility Phone Number: 763 324-4823

Facility Type: Prison

Certificate Type: Waiver

NPI Number: 1417154220

Taxonomy: 101Y00000X - Counselor
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

CLIA Record

Field Name	Field Value
CLIA Number	24D2274336
LAB Type	Prison
Facility Name	ANOKA COUNTY JUVENILE CENTER
Street	7555 4TH AVENUE
City	LINO LAKES
State	MN
ZIP	55014
Phone	763 324-4823
CertificateType	4
CertificateEffectiveDate	1/3/2023
CertificateExpirationDate	1/2/2025
FacilityType	Waiver

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