Provider Demographics
NPI:1912470469
Name:NUTRITION THERAPY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:NUTRITION THERAPY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIETITIAN, COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:MAPC, RDN, LD
Authorized Official - Phone:972-762-0176
Mailing Address - Street 1:9114 LYNBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2833
Mailing Address - Country:US
Mailing Address - Phone:972-762-0176
Mailing Address - Fax:972-476-1097
Practice Address - Street 1:10000 N CENTRAL EXPY STE 413B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4112
Practice Address - Country:US
Practice Address - Phone:972-762-0176
Practice Address - Fax:972-476-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty