45D2312594 CLIA NUMBER - PB BEHAVIORAL BRAZOS VALLEY, LLC DBA PROMISES DALLAS FORT WORTH

Laboratory Demographics

  • CLIA Code: 45D2312594
  • Facility Name: PB BEHAVIORAL BRAZOS VALLEY, LLC DBA PROMISES DALLAS FORT WORTH
  • Facility Address: 400 HIGHLAND DRIVE
    LEWISVILLE, TX
    ZIP 75067
  • Facility Phone: 940 531-2122
  • Facility Type: Other - CHEM DEPEND TREATMENT
  • Facility Type: Waiver
  • Lab Director: CASSANDRA BODUCH
  • NPI Number: 1801484340
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 45D2312594
LAB Type Other - CHEM DEPEND TREATMENT
Facility Name PB BEHAVIORAL BRAZOS VALLEY, LLC DBA PROMISES DALLAS FORT WORTH
Street 400 HIGHLAND DRIVE
City LEWISVILLE
State TX
ZIP 75067
Phone 940 531-2122
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/15/2024
Certificate Expiration Date 10/14/2026
Facility Type Other - CHEM DEPEND TREATMENT
Lab Director CASSANDRA BODUCH

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