Provider Demographics
NPI:1639889777
Name:MINDFUL NUTRITION COUNSELING LLC
Entity Type:Organization
Organization Name:MINDFUL NUTRITION COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELBIE
Authorized Official - Middle Name:CALK
Authorized Official - Last Name:GREENVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-205-1721
Mailing Address - Street 1:316 EDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-7518
Mailing Address - Country:US
Mailing Address - Phone:936-205-1721
Mailing Address - Fax:866-259-8676
Practice Address - Street 1:2400 N STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-1222
Practice Address - Country:US
Practice Address - Phone:936-205-1721
Practice Address - Fax:866-259-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty