Provider Demographics
NPI:1639316581
Name:NUTRITION THERAPY, LLC
Entity Type:Organization
Organization Name:NUTRITION THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:248-244-2213
Mailing Address - Street 1:700 E BIG BEAVER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1435
Mailing Address - Country:US
Mailing Address - Phone:248-244-2213
Mailing Address - Fax:248-275-5558
Practice Address - Street 1:700 E BIG BEAVER RD
Practice Address - Street 2:SUITE B
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1435
Practice Address - Country:US
Practice Address - Phone:248-244-2213
Practice Address - Fax:248-275-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty