45D2300232 CLIA NUMBER - MIND BODY OPTIMIZATION, SOUTHLAKE

Laboratory Demographics

  • CLIA Code: 45D2300232
  • Facility Name: MIND BODY OPTIMIZATION, SOUTHLAKE
  • Facility Address: 271 E SOUTHLAKE BLVD
    SOUTHLAKE, TX
    ZIP 76092
  • Facility Phone: 682 224-8196
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: JOSHUA WARREN
  • NPI Number: 1700656873
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 45D2300232
LAB Type Community Clinic
Facility Name MIND BODY OPTIMIZATION, SOUTHLAKE
Street 271 E SOUTHLAKE BLVD
City SOUTHLAKE
State TX
ZIP 76092
Phone 682 224-8196
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/6/2024
Certificate Expiration Date 3/5/2026
Facility Type Community Clinic
Lab Director JOSHUA WARREN

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