MEDICARE: RADIANT BEHAVIORAL HEALTH GROUP PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1184559254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT BEHAVIORAL HEALTH GROUP PLLC

Provider Business Mailing Address
First Line	:	4815 BRYANT MEADOWS DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-1060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4815 BRYANT MEADOWS DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-1060
Country	:	US
Telephone Number	:	518-961-3899
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSHUA BOTCHWAY
Credential	:
Telephone Number	:	518-961-3899

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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