25D0712213 CLIA NUMBER - MEMORIAL BRUNI PEDIATRIC CLINIC

Laboratory Demographics

CLIA Number: 25D0712213

Facility Name: MEMORIAL BRUNI PEDIATRIC CLINIC

Facility Address:
9454 THREE RIVERS ROAD SUITE A
GULFPORT, MS
ZIP 39503
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Facility Phone Number: 228 575-2300

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1932122017

Taxonomy: 103TB0200X - Psychologist
A psychologist who reflects an experimental-clinical approach distinguished by use of principles of human learning and development and theories of cognitive processing to promote meaningful change in maladaptive human behavior and thinking.

CLIA Record

Field Name	Field Value
CLIA Number	25D0712213
LAB Type	Physician Office
Facility Name	MEMORIAL BRUNI PEDIATRIC CLINIC
Street	9454 THREE RIVERS ROAD SUITE A
City	GULFPORT
State	MS
ZIP	39503
Phone	228 575-2300
CertificateType	3
CertificateEffectiveDate	4/2/2023
CertificateExpirationDate	4/1/2025
FacilityType	PPMP

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