Organization
RADIANT PATH THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANDON EHTESHAMZADEH (CO-OWNER)
(951) 205-2949
Entity
Organization
Contact information
Practice address
12139 MOUNT VERNON AVE STE 210, GRAND TERRACE, CA 92313-5562
(951) 205-2949
Mailing address
12139 MOUNT VERNON AVE STE 210, GRAND TERRACE, CA 92313-5562
(951) 205-2949
(866) 365-2227
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
12/03/2024
Last updated
01/02/2026
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