45D2114500 CLIA NUMBER - MIND ABOVE MATTER, LLC-KELLER

Laboratory Demographics

  • CLIA Code: 45D2114500
  • Facility Name: MIND ABOVE MATTER, LLC-KELLER
  • Facility Address: 4232 HERITAGE TRACE PKWY
    KELLER, TX
    ZIP 76244
  • Facility Phone: 817 447-3001
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JESSE TUCKER
  • NPI Number: 1891142063
  • Taxonomy: 101YP2500X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 45D2114500
LAB Type Physician Office
Facility Name MIND ABOVE MATTER, LLC-KELLER
Street 4232 HERITAGE TRACE PKWY
City KELLER
State TX
ZIP 76244
Phone 817 447-3001
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/15/2024
Certificate Expiration Date 6/14/2026
Facility Type Physician Office
Lab Director JESSE TUCKER

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