25D2054941 CLIA NUMBER - INNOVATIVE BEHAVORIAL SERVICES INC

Laboratory Demographics

  • CLIA Code: 25D2054941
  • Facility Name: INNOVATIVE BEHAVORIAL SERVICES INC
  • Facility Address: 357 TOWNE CENTER BLVD STE 100
    RIDGELAND, MS
    ZIP 39157
  • Facility Phone: 601 952-0894
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CLYDE E. GLENN
  • NPI Number: 1578578092
  • Taxonomy: 1041C0700X - Social Worker

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CLIA Record

Field Name Field Value
CLIA Number 25D2054941
LAB Type Physician Office
Facility Name INNOVATIVE BEHAVORIAL SERVICES INC
Street 357 TOWNE CENTER BLVD STE 100
City RIDGELAND
State MS
ZIP 39157
Phone 601 952-0894
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/1/2025
Certificate Expiration Date 2/28/2027
Facility Type Physician Office
Lab Director CLYDE E. GLENN

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