Provider Demographics
NPI:1609613041
Name:RAYDIANT THERAPY PLLC
Entity type:Organization
Organization Name:RAYDIANT THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUPPKE
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:248-762-9777
Mailing Address - Street 1:929 HILLDALE DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1605
Mailing Address - Country:US
Mailing Address - Phone:248-762-9777
Mailing Address - Fax:
Practice Address - Street 1:929 HILLDALE DR
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1605
Practice Address - Country:US
Practice Address - Phone:248-762-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty