Provider Demographics
NPI:1952125999
Name:SELF-MADE LIFESTYLE LLC
Entity type:Organization
Organization Name:SELF-MADE LIFESTYLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CLINICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LCADC
Authorized Official - Phone:908-251-1212
Mailing Address - Street 1:180 TALMADGE RD STE 831
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2860
Mailing Address - Country:US
Mailing Address - Phone:908-251-1212
Mailing Address - Fax:
Practice Address - Street 1:180 TALMADGE RD STE 831
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2860
Practice Address - Country:US
Practice Address - Phone:908-251-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty