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36D2104241 CLIA NUMBER - WORTHINGTON CONSULTATION & BEHAVIORAL MEDICINE

Laboratory Demographics

CLIA Number: 36D2104241

Facility Name: WORTHINGTON CONSULTATION & BEHAVIORAL MEDICINE

Facility Address:
134 NORTHWOODS BLVD SUITE B1
COLUMBUS, OH
ZIP 43235
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Facility Phone Number: 614 846-6611

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1881753036

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name Field Value
CLIA Number 36D2104241
LAB Type Physician Office
Facility Name WORTHINGTON CONSULTATION & BEHAVIORAL MEDICINE
Street 134 NORTHWOODS BLVD SUITE B1
City COLUMBUS
State OH
ZIP 43235
Phone 614 846-6611
CertificateType 4
CertificateEffectiveDate 10/30/2023
CertificateExpirationDate 10/29/2025
FacilityType Waiver

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