Provider Demographics
NPI:1033800586
Name:RADIANT LEAF COUNSELING
Entity Type:Organization
Organization Name:RADIANT LEAF COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ATSACHANH
Authorized Official - Middle Name:
Authorized Official - Last Name:NONNARATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-459-3747
Mailing Address - Street 1:2575 NW MARSHALL ST APT 8
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2888
Mailing Address - Country:US
Mailing Address - Phone:503-459-3747
Mailing Address - Fax:
Practice Address - Street 1:2575 NW MARSHALL ST APT 8
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2888
Practice Address - Country:US
Practice Address - Phone:503-459-3747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty