Organization
JL BASTIAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY IWOTOR (CEO/DIRECTOR)
(404) 313-5129
Entity
Organization
Contact information
Practice address
26210 RADIANT RIVER TRL, RICHMOND, TX 77406-3161
(404) 313-5129
Mailing address
26210 RADIANT RIVER TRL, RICHMOND, TX 77406-3161
(404) 313-5129
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
03/11/2026
Last updated
03/11/2026
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