Provider Demographics
NPI:1871846568
Name:RADIANT PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:RADIANT PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PERRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORVINO
Authorized Official - Suffix:
Authorized Official - Credentials:LSW, MA, CAC I
Authorized Official - Phone:303-859-7630
Mailing Address - Street 1:190 E 9TH AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2744
Mailing Address - Country:US
Mailing Address - Phone:303-859-7630
Mailing Address - Fax:720-398-3263
Practice Address - Street 1:190 E 9TH AVE STE 190
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2744
Practice Address - Country:US
Practice Address - Phone:303-859-7630
Practice Address - Fax:720-398-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO899104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty