Provider Demographics
NPI:1972313922
Name:RADIANT THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:RADIANT THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-663-1214
Mailing Address - Street 1:2124 NEWCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-4453
Mailing Address - Country:US
Mailing Address - Phone:708-663-1214
Mailing Address - Fax:
Practice Address - Street 1:1011 LAKE ST STE 210
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1137
Practice Address - Country:US
Practice Address - Phone:708-663-1214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty