| Jl Bastian Llc | |
|
26210 Radiant River Trl Richmond TX 77406-3161 | |
| (404) 313-5129 | |
| Not Available |
| Full Name | Jl Bastian Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 26210 Radiant River Trl, Richmond, Texas |
| Authorized Official Name and Position | Anthony Iwotor (CEO/DIRECTOR) |
| Authorized Official Contact | 4043135129 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jl Bastian Llc 26210 Radiant River Trl Richmond TX 77406-3161 Ph: (404) 313-5129 | Jl Bastian Llc 26210 Radiant River Trl Richmond TX 77406-3161 Ph: (404) 313-5129 |
| NPI Number | 1528915394 |
|---|---|
| Provider Enumeration Date | 03/11/2026 |
| Last Update Date | 03/11/2026 |
| Certification Date | 03/11/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528915394 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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