25D1056894 CLIA NUMBER - PSYCAMORE PSYCHIATRIC PROGRAM, LLC

Laboratory Demographics

  • CLIA Code: 25D1056894
  • Facility Name: PSYCAMORE PSYCHIATRIC PROGRAM, LLC
  • Facility Address: 2540 FLOWOOD DRIVE
    FLOWOOD, MS
    ZIP 39232
  • Facility Phone: 601 939-5993
  • Facility Type: Other - BEHAVIORAL HLTH PHP & IOP
  • Facility Type: Waiver
  • Lab Director: SUDHAKAR MADAKASIRA
  • NPI Number: 1043465040
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D1056894
LAB Type Other - BEHAVIORAL HLTH PHP & IOP
Facility Name PSYCAMORE PSYCHIATRIC PROGRAM, LLC
Street 2540 FLOWOOD DRIVE
City FLOWOOD
State MS
ZIP 39232
Phone 601 939-5993
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/24/2024
Certificate Expiration Date 2/23/2026
Facility Type Other - BEHAVIORAL HLTH PHP & IOP
Lab Director SUDHAKAR MADAKASIRA

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