Provider Demographics
NPI:1982581351
Name:RADIANT CHANGE BEHAVIORAL SERVICES LLC
Entity type:Organization
Organization Name:RADIANT CHANGE BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:BLADES
Authorized Official - Suffix:
Authorized Official - Credentials:M ED
Authorized Official - Phone:509-617-6613
Mailing Address - Street 1:2504 194TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8575
Mailing Address - Country:US
Mailing Address - Phone:509-617-6613
Mailing Address - Fax:253-276-7129
Practice Address - Street 1:2504 194TH STREET CT E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8575
Practice Address - Country:US
Practice Address - Phone:509-617-6613
Practice Address - Fax:253-276-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-18
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty