Provider Demographics
NPI:1831953363
Name:JOURNEY TO SUCCESS - LIFESTYLE NUTRITION, LLC
Entity type:Organization
Organization Name:JOURNEY TO SUCCESS - LIFESTYLE NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAULDIN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:918-212-6216
Mailing Address - Street 1:13315 E 112TH ST N STE 203
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-8376
Mailing Address - Country:US
Mailing Address - Phone:918-212-6216
Mailing Address - Fax:918-308-3286
Practice Address - Street 1:13315 E 112TH ST N STE 203
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-8376
Practice Address - Country:US
Practice Address - Phone:918-212-6216
Practice Address - Fax:918-308-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty