Provider Demographics
NPI:1467804039
Name:RADIANCE COUNSELING, LLC
Entity Type:Organization
Organization Name:RADIANCE COUNSELING, LLC
Other - Org Name:RADIANCE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BEHAVIORAL HEALTH PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LAC
Authorized Official - Phone:303-726-6131
Mailing Address - Street 1:827 N GRANT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2902
Mailing Address - Country:US
Mailing Address - Phone:720-432-5223
Mailing Address - Fax:
Practice Address - Street 1:827 N GRANT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2902
Practice Address - Country:US
Practice Address - Phone:720-432-5223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012439251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1689095929Medicaid