53D2302649 CLIA NUMBER - KINTSUGI PSYCHIATRY LLC

Laboratory Demographics

  • CLIA Code: 53D2302649
  • Facility Name: KINTSUGI PSYCHIATRY LLC
  • Facility Address: 145 SOUTH DURBIN STREET, SUITE 108
    CASPER, WY
    ZIP 82601
  • Facility Phone: 307 333-5757
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TEECEE HAILEY-FULFER
  • NPI Number: 1306406509
  • Taxonomy: 363LP0808X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 53D2302649
LAB Type Physician Office
Facility Name KINTSUGI PSYCHIATRY LLC
Street 145 SOUTH DURBIN STREET, SUITE 108
City CASPER
State WY
ZIP 82601
Phone 307 333-5757
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2024
Certificate Expiration Date 4/11/2026
Facility Type Physician Office
Lab Director TEECEE HAILEY-FULFER

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