Provider Demographics
NPI:1427306547
Name:LOVE TO LIVE WELL
Entity type:Organization
Organization Name:LOVE TO LIVE WELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RD, LD, MCHES
Authorized Official - Phone:877-978-9355
Mailing Address - Street 1:1011 SURREY DR BLDG 200
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4234
Mailing Address - Country:US
Mailing Address - Phone:877-978-9355
Mailing Address - Fax:940-312-7283
Practice Address - Street 1:1011 SURREY DR BLDG 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4234
Practice Address - Country:US
Practice Address - Phone:877-978-9355
Practice Address - Fax:940-312-7283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81688133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty