35D2079903 CLIA NUMBER - SOUTHEAST BEHAVIORAL HEALTH CLINIC - MED SERVICES

Laboratory Demographics

  • CLIA Code: 35D2079903
  • Facility Name: SOUTHEAST BEHAVIORAL HEALTH CLINIC - MED SERVICES
  • Facility Address: 2624 9TH AVE S
    FARGO, ND
    ZIP 58103
  • Facility Phone: 701 298-4500
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: LORI J. ESPRIT
  • NPI Number: 1932146941
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 35D2079903
LAB Type Community Clinic
Facility Name SOUTHEAST BEHAVIORAL HEALTH CLINIC - MED SERVICES
Street 2624 9TH AVE S
City FARGO
State ND
ZIP 58103
Phone 701 298-4500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/21/2025
Certificate Expiration Date 7/20/2027
Facility Type Community Clinic
Lab Director LORI J. ESPRIT

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