Provider Demographics
NPI:1154072189
Name:WISE NUTRITION COUNSELING LLC
Entity Type:Organization
Organization Name:WISE NUTRITION COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:210-797-6295
Mailing Address - Street 1:5817 SHORT SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-6452
Mailing Address - Country:US
Mailing Address - Phone:210-797-6295
Mailing Address - Fax:
Practice Address - Street 1:16980 DALLAS PKWY STE 204
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1910
Practice Address - Country:US
Practice Address - Phone:210-797-6295
Practice Address - Fax:469-731-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty