Provider Demographics
NPI:1811656606
Name:FOOD FRAME OF MIND
Entity type:Organization
Organization Name:FOOD FRAME OF MIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHULSUKSOMBATI
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:240-285-9117
Mailing Address - Street 1:1544 TRAFALGAR LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-2528
Mailing Address - Country:US
Mailing Address - Phone:240-285-9117
Mailing Address - Fax:
Practice Address - Street 1:1544 TRAFALGAR LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-2528
Practice Address - Country:US
Practice Address - Phone:240-285-9117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty