Provider Demographics
NPI:1275765588
Name:RADIANT HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:RADIANT HEALTH SERVICES, INC.
Other - Org Name:RADIANT HEALTH SERVICES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-FELIX
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-649-1320
Mailing Address - Street 1:1035 S STATE ROAD 7 STE 315-14
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6134
Mailing Address - Country:US
Mailing Address - Phone:561-649-1320
Mailing Address - Fax:
Practice Address - Street 1:1035 S STATE ROAD 7 STE 315-14
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6134
Practice Address - Country:US
Practice Address - Phone:561-649-1320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 7686251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6139AMedicare UPIN