Provider Demographics
NPI:1588263404
Name:MEDICAL NUTRITION THERAPY CONSULTING LLC
Entity type:Organization
Organization Name:MEDICAL NUTRITION THERAPY CONSULTING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:WASHINGTON,
Authorized Official - Middle Name:AISHA
Authorized Official - Last Name:L
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:816-572-0471
Mailing Address - Street 1:12404 BLUE RIDGE EXT
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1741
Mailing Address - Country:US
Mailing Address - Phone:816-572-0471
Mailing Address - Fax:816-761-0478
Practice Address - Street 1:12404 BLUE RIDGE EXT
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1741
Practice Address - Country:US
Practice Address - Phone:816-572-0471
Practice Address - Fax:816-761-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No252Y00000XAgenciesEarly Intervention Provider Agency