Provider Demographics
NPI:1962162768
Name:HEALTHY LIFESTYLE SOLUTIONS, LLC
Entity type:Organization
Organization Name:HEALTHY LIFESTYLE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD, CDCES
Authorized Official - Phone:502-792-7066
Mailing Address - Street 1:1400 MAIN ST UNIT 194
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-3121
Mailing Address - Country:US
Mailing Address - Phone:502-792-7066
Mailing Address - Fax:
Practice Address - Street 1:1400 MAIN ST UNIT 194
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-3121
Practice Address - Country:US
Practice Address - Phone:502-792-7066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty