Provider Demographics
NPI:1790300952
Name:TRUE TO LIFE NUTRITION COUNSELING AND CONSULTING, INC.
Entity Type:Organization
Organization Name:TRUE TO LIFE NUTRITION COUNSELING AND CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:660-473-0418
Mailing Address - Street 1:10501 W 113TH ST APT 5304
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2553
Mailing Address - Country:US
Mailing Address - Phone:913-369-4694
Mailing Address - Fax:833-456-9121
Practice Address - Street 1:1305 MATHIES AVE
Practice Address - Street 2:
Practice Address - City:WHITEMAN AFB
Practice Address - State:MO
Practice Address - Zip Code:65305-1184
Practice Address - Country:US
Practice Address - Phone:660-473-0418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-13
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty