36D2296233 CLIA NUMBER - MODERN PSYCHIATRY AND WELLNESS, LLC

Laboratory Demographics

  • CLIA Code: 36D2296233
  • Facility Name: MODERN PSYCHIATRY AND WELLNESS, LLC
  • Facility Address: 7162 LIBERTY CENTRE DR
    LIBERTY TOWNSHIP, OH
    ZIP 45069
  • Facility Phone: 513 795-7557
  • Facility Type: Other - OUTPATIENT BEHAVIORAL HEA
  • Facility Type: Waiver
  • Lab Director: QUINTON E. MOSS
  • NPI Number: 1699251553
  • Taxonomy: 261QM0850X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 36D2296233
LAB Type Other - OUTPATIENT BEHAVIORAL HEA
Facility Name MODERN PSYCHIATRY AND WELLNESS, LLC
Street 7162 LIBERTY CENTRE DR
City LIBERTY TOWNSHIP
State OH
ZIP 45069
Phone 513 795-7557
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2023
Certificate Expiration Date 12/21/2025
Facility Type Other - OUTPATIENT BEHAVIORAL HEA
Lab Director QUINTON E. MOSS

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