Organization
ROUNDTABLE WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE M TILT RDN, CSP (OWNER & REGISTERED DIETITIAN)
(765) 630-7222
Entity
Organization
Contact information
Practice address
904 SOUTH ST, LAFAYETTE, IN 47901-1416
(765) 630-7222
Mailing address
904 SOUTH ST, LAFAYETTE, IN 47901-1416
(765) 630-7222
(765) 807-3210
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
133V00000X
Registered Dietitian
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/08/2016
Last updated
12/23/2024
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