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General NPI Number Information
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NPI Number | 1467804039
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Entity Type | Organization
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Legal Business Name | RADIANCE COUNSELING, LLC
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Dates
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Enumeration Date | 07/07/2016
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 827 N GRANT ST
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City | DENVER
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State | CO
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Zip | 80203-2902
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Country | US
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Telephone | 720-432-5223
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Fax |
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Provider Business Mailing Address
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Address Line | 827 N GRANT ST
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City | DENVER
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State | CO
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Zip | 80203-2902
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Country | US
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Telephone | 720-432-5223
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Fax |
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Authorized Official
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Title or Position | BEHAVIORAL HEALTH PROFESSIONAL
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Name | JESSICA RUTH SMITH
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Credential | LPC, LAC
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Telephone | 303-726-6131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC.0012439
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License Number State | CO
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