Provider Demographics
NPI:1275347395
Name:RADIANT HEART THERAPY PROFESSIONAL LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:RADIANT HEART THERAPY PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAHARA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BUNNA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT, LPC, NCC
Authorized Official - Phone:818-618-3619
Mailing Address - Street 1:514 COUNTY ROAD 2730
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-7518
Mailing Address - Country:US
Mailing Address - Phone:818-618-3619
Mailing Address - Fax:
Practice Address - Street 1:514 COUNTY ROAD 2730
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-7518
Practice Address - Country:US
Practice Address - Phone:818-618-3619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty