Healthcare Provider Details

I. General information

NPI: 1720524788
Provider Name (Legal Business Name): LYFE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2017
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 E 2ND ST
DOVER OH
44622-1268
US

IV. Provider business mailing address

1225 E 2ND ST
DOVER OH
44622-1268
US

V. Phone/Fax

Practice location:
  • Phone: 330-204-8420
  • Fax:
Mailing address:
  • Phone: 330-204-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number7286
License Number StateOH

VIII. Authorized Official

Name: ALLISON PORTER
Title or Position: OWNER
Credential: RDN, LD
Phone: 330-204-8420