Provider Demographics
NPI:1417549353
Name:CARLY JANAK NUTRITION THERAPY LLC
Entity type:Organization
Organization Name:CARLY JANAK NUTRITION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:REED
Authorized Official - Last Name:JANAK
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:281-796-3274
Mailing Address - Street 1:5405 DE LANGE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-4209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5405 DE LANGE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-4209
Practice Address - Country:US
Practice Address - Phone:281-796-3274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty