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General NPI Number Information
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NPI Number | 1770438822
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Entity Type | Organization
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Legal Business Name | RADIANT PATH MARRIAGE AND FAMILY THERAPY, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 308 W STATE ST
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City | REDLANDS
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State | CA
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Zip | 92373-4653
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Country | US
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Telephone | 909-577-1124
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Fax |
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Provider Business Mailing Address
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Address Line | 308 W STATE ST
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City | REDLANDS
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State | CA
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Zip | 92373-4653
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Country | US
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Telephone | 909-577-1124
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | LANDON EHTESHAMZADEH
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Credential |
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Telephone | 951-205-2949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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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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