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General NPI Number Information
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NPI Number | 1699470450
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Entity Type | Organization
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Legal Business Name | RADIANT RECOVERY & COUNSELING SERVICES
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | 400 S 4TH ST STE 401
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-1419
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Country | US
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Telephone | 612-429-1662
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Fax | 612-234-4788
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Provider Business Mailing Address
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Address Line | 400 S 4TH ST STE 401
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-1419
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Country | US
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Telephone | 612-429-1662
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Fax | 612-234-4788
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Authorized Official
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Title or Position | OWNER/DRECTOR
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Name | ALEX LOMOSI
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Credential |
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Telephone | 561-889-3924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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