Provider Demographics
NPI:1184197816
Name:FLOURISH. NUTRITION THERAPY
Entity Type:Organization
Organization Name:FLOURISH. NUTRITION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:N
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:314-605-3287
Mailing Address - Street 1:6222 POTOMAC ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2011
Mailing Address - Country:US
Mailing Address - Phone:314-605-3287
Mailing Address - Fax:
Practice Address - Street 1:6222 POTOMAC ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2011
Practice Address - Country:US
Practice Address - Phone:314-605-3287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health