Provider Demographics
NPI:1902100167
Name:THERAPEUTIC LIFESTYLE CHANGES, INC
Entity Type:Organization
Organization Name:THERAPEUTIC LIFESTYLE CHANGES, INC
Other - Org Name:HEALTHY U
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEUTSCH-KEAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RD
Authorized Official - Phone:248-508-7827
Mailing Address - Street 1:15960 MARGUERITE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5630
Mailing Address - Country:US
Mailing Address - Phone:248-508-7827
Mailing Address - Fax:248-644-6121
Practice Address - Street 1:22750 WOODWARD AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1777
Practice Address - Country:US
Practice Address - Phone:248-508-7827
Practice Address - Fax:248-644-6121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1215188560OtherINDIVIDUAL NPI NUMBER
MI0N74740Medicare PIN