Organization
LIFEFUL AGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY HARBOLIC MS, RDN, BCC (FOUNDER)
(480) 813-9989
Entity
Organization
Contact information
Practice address
6633 W VIA MONTOYA DR, GLENDALE, AZ 85310-5714
(480) 813-9989
Mailing address
6633 W VIA MONTOYA DR, GLENDALE, AZ 85310-5714
(480) 813-9989
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
133V00000X
Registered Dietitian
Primary
—
—
133VN1101X
Gerontological Nutrition Registered Dietitian
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
171400000X
Health & Wellness Coach
—
—
Other
Enumeration date
05/13/2024
Last updated
05/13/2024
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