Provider Demographics
NPI:1992411391
Name:RADAR, LLC
Entity type:Organization
Organization Name:RADAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MA, LPCC, LADC
Authorized Official - Phone:612-747-1127
Mailing Address - Street 1:2850 ABBEY PLZ # 6044
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56321-7700
Mailing Address - Country:US
Mailing Address - Phone:612-747-1127
Mailing Address - Fax:
Practice Address - Street 1:2546 FRUIT FARM RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:MN
Practice Address - Zip Code:56321-2700
Practice Address - Country:US
Practice Address - Phone:320-363-2045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty