26D0441805 CLIA NUMBER - SOUTHEAST MISSOURI MENTAL HEALTH CTR

Laboratory Demographics

CLIA Number: 26D0441805

Facility Name: SOUTHEAST MISSOURI MENTAL HEALTH CTR

Facility Address:
1010 W COLUMBIA
FARMINGTON, MO
ZIP 63640
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Facility Phone Number: 573 218-6724

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1023176054

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D0441805
LAB Type	Other
Facility Name	SOUTHEAST MISSOURI MENTAL HEALTH CTR
Street	1010 W COLUMBIA
City	FARMINGTON
State	MO
ZIP	63640
Phone	573 218-6724
CertificateType	4
CertificateEffectiveDate	1/3/2023
CertificateExpirationDate	1/2/2025
FacilityType	Waiver

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