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NPI Code Detail

MEDICARE: RADIANT LIVING BEHAVIORAL HEALTH PLLC

MEDICARE: RADIANT LIVING BEHAVIORAL HEALTH 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
11041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992370183
Entity Type Code : Organization
Provider Name (Legal Business Name) : RADIANT LIVING BEHAVIORAL HEALTH PLLC
Provider Business Mailing Address
First Line : 11450 VERAZAE DR
Second Line :
City : RENO
State : NV
Zip : 89521-3154
Country : US
Telephone Number : 775-338-8437
Fax Number :
Provider Business Practice Location Address
First Line : 10631 PROFESSIONAL CIR STE A
Second Line :
City : RENO
State : NV
Zip : 89521-5835
Country : US
Telephone Number : 775-826-6218
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : RACHEL BLINN
Credential : LCSW
Telephone Number : 775-338-8437
Provider Enumeration Date : 05/21/2021
Last Update Date : 05/21/2021

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