Healthcare Provider Details

I. General information

NPI: 1750199220
Provider Name (Legal Business Name): RADIANT LIFE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 30TH ST
BOULDER CO
80301-1088
US

IV. Provider business mailing address

4869 KELLOGG CIR
BOULDER CO
80303-1110
US

V. Phone/Fax

Practice location:
  • Phone: 303-503-9755
  • Fax:
Mailing address:
  • Phone: 303-503-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOY REDSTONE
Title or Position: OWNER
Credential: LCSW
Phone: 303-503-9755