Provider Demographics
NPI:1528729860
Name:HEALING NUTRITION THERAPY OF LOUISIANA
Entity type:Organization
Organization Name:HEALING NUTRITION THERAPY OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:HAYS
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:318-614-5097
Mailing Address - Street 1:1502 STUBBS AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5628
Mailing Address - Country:US
Mailing Address - Phone:318-614-5097
Mailing Address - Fax:
Practice Address - Street 1:1502 STUBBS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5628
Practice Address - Country:US
Practice Address - Phone:318-614-5097
Practice Address - Fax:855-932-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-08
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2190962Medicaid