50D2148391 CLIA NUMBER - PSYCHIATRIC SERVICES AND MEDICATION MANAGEMENT

Laboratory Demographics

  • CLIA Code: 50D2148391
  • Facility Name: PSYCHIATRIC SERVICES AND MEDICATION MANAGEMENT
  • Facility Address: 12615 E MISSION AVE STE 310
    SPOKANE VALLEY, WA
    ZIP 99216
  • Facility Phone: 509 707-8581
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FRED ITVELDT
  • NPI Number: 1710477807
  • Taxonomy: 363LP0808X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 50D2148391
LAB Type Physician Office
Facility Name PSYCHIATRIC SERVICES AND MEDICATION MANAGEMENT
Street 12615 E MISSION AVE STE 310
City SPOKANE VALLEY
State WA
ZIP 99216
Phone 509 707-8581
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2018
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director FRED ITVELDT

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