MEDICARE: G IVES NUTRITION THERAPY LLC

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
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1871053843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G IVES NUTRITION THERAPY LLC

Provider Business Mailing Address
First Line	:	3035 OXFORDSHIRE LN
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-3615
Country	:	US
Telephone Number	:	214-538-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	3144 TEX BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4224
Country	:	US
Telephone Number	:	214-538-6565
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	VIRGINIA IVES
Credential	:	RDN, LPC
Telephone Number	:	214-538-6565

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	05/19/2022

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