Provider Demographics
NPI:1659017770
Name:MIND BODY NUTRITION COUNSELING, LLC
Entity Type:Organization
Organization Name:MIND BODY NUTRITION COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOKER
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LPCC
Authorized Official - Phone:970-980-8732
Mailing Address - Street 1:3345 W ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-3479
Mailing Address - Country:US
Mailing Address - Phone:605-214-4433
Mailing Address - Fax:
Practice Address - Street 1:1101 E ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4022
Practice Address - Country:US
Practice Address - Phone:970-980-8732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty