Provider Demographics
NPI:1922601947
Name:MENTHA NUTRITION COUNSELING, LLC
Entity Type:Organization
Organization Name:MENTHA NUTRITION COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER, RD
Authorized Official - Prefix:
Authorized Official - First Name:KAYTLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:MED, RD, LDN
Authorized Official - Phone:971-404-4705
Mailing Address - Street 1:715 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97113-6926
Mailing Address - Country:US
Mailing Address - Phone:971-404-4705
Mailing Address - Fax:
Practice Address - Street 1:620 SE OAK ST STE E
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4160
Practice Address - Country:US
Practice Address - Phone:503-747-3096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty