MEDICARE: HEALTHY LIVING HEALTHY FLAVORS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1861720161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY LIVING HEALTHY FLAVORS

Provider Business Mailing Address
First Line	:	507 PRESSLER ST
Second Line	:	#2124
City	:	AUSTIN
State	:	TX
Zip	:	78703-5151
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 PRESSLER ST
Second Line	:	#2124
City	:	AUSTIN
State	:	TX
Zip	:	78703-5151
Country	:	US
Telephone Number	:	620-757-5864
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALLISON STEVENS
Credential	:	MS, RD
Telephone Number	:	620-757-5864

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	11/24/2009

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