Provider Demographics
NPI:1033968268
Name:RADIANT ALLY THERAPY & CONSULTING SERVICES, LLC
Entity type:Organization
Organization Name:RADIANT ALLY THERAPY & CONSULTING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RA
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:417-719-0973
Mailing Address - Street 1:4195 E SUMMER SET ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-9776
Mailing Address - Country:US
Mailing Address - Phone:417-719-0973
Mailing Address - Fax:
Practice Address - Street 1:1911 S NATIONAL AVE STE 401
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2213
Practice Address - Country:US
Practice Address - Phone:417-719-0973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health