Provider Demographics
NPI:1740575638
Name:HEALTHY LIFESTYLES PLLC
Entity Type:Organization
Organization Name:HEALTHY LIFESTYLES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NIMISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RD/LD
Authorized Official - Phone:469-854-1656
Mailing Address - Street 1:1514 N GREENVILLE AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-1202
Mailing Address - Country:US
Mailing Address - Phone:469-854-1656
Mailing Address - Fax:
Practice Address - Street 1:1514 N GREENVILLE AVE STE 310
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-1205
Practice Address - Country:US
Practice Address - Phone:469-854-1656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-19
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX427281041C0700X
TXDT80265133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty