Provider Demographics
NPI:1104652262
Name:BALANCED NUTRITION COUNSELING
Entity type:Organization
Organization Name:BALANCED NUTRITION COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:NICAR
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:405-808-5697
Mailing Address - Street 1:3030 NW EXPRESSWAY STE 300
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5400
Mailing Address - Country:US
Mailing Address - Phone:405-217-3646
Mailing Address - Fax:405-259-1444
Practice Address - Street 1:3030 NW EXPRESSWAY STE 300
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5400
Practice Address - Country:US
Practice Address - Phone:405-808-5697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty