25D2190688 CLIA NUMBER - FAIR PARK COUNSELING PLLC

Laboratory Demographics

  • CLIA Code: 25D2190688
  • Facility Name: FAIR PARK COUNSELING PLLC
  • Facility Address: 210 E MAIN ST STE 2C
    TUPELO, MS
    ZIP 38804
  • Facility Phone: 662 760-0052
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: KELLY W. FERGUSON
  • NPI Number: 1730661331
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2190688
LAB Type Practitioner Other
Facility Name FAIR PARK COUNSELING PLLC
Street 210 E MAIN ST STE 2C
City TUPELO
State MS
ZIP 38804
Phone 662 760-0052
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/18/2024
Certificate Expiration Date 8/17/2026
Facility Type Practitioner Other
Lab Director KELLY W. FERGUSON

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