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NPI Code Detail

MEDICARE: JL BASTIAN LLC

MEDICARE: JL BASTIAN LLC
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
1261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1528915394
Entity Type Code : Organization
Provider Name (Legal Business Name) : JL BASTIAN LLC
Provider Business Mailing Address
First Line : 26210 RADIANT RIVER TRL
Second Line :
City : RICHMOND
State : TX
Zip : 77406-3161
Country : US
Telephone Number : 404-313-5129
Fax Number :
Provider Business Practice Location Address
First Line : 26210 RADIANT RIVER TRL
Second Line :
City : RICHMOND
State : TX
Zip : 77406-3161
Country : US
Telephone Number : 404-313-5129
Fax Number :
Authorized Official
Title or Position : CEO/DIRECTOR
Name : ANTHONY IWOTOR
Credential :
Telephone Number : 404-313-5129
Provider Enumeration Date : 03/11/2026
Last Update Date : 03/11/2026

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Directions to “JL BASTIAN LLC ” Practice Location

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