25D2116428 CLIA NUMBER - IMAGINE BEHAVIORAL HEALTH

Laboratory Demographics

  • CLIA Code: 25D2116428
  • Facility Name: IMAGINE BEHAVIORAL HEALTH
  • Facility Address: 1920 DUNBARTON DR
    JACKSON, MS
    ZIP 39216
  • Facility Phone: 601 982-5376
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BAXTER H. HOGUE
  • NPI Number: 1902052962
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2116428
LAB Type Physician Office
Facility Name IMAGINE BEHAVIORAL HEALTH
Street 1920 DUNBARTON DR
City JACKSON
State MS
ZIP 39216
Phone 601 982-5376
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/26/2024
Certificate Expiration Date 7/25/2026
Facility Type Physician Office
Lab Director BAXTER H. HOGUE

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