Provider Demographics
NPI:1003359126
Name:JENNIFER RATLIFF-MOSS LMSW, LLC
Entity Type:Organization
Organization Name:JENNIFER RATLIFF-MOSS LMSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RATLIFF-MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-905-6649
Mailing Address - Street 1:4008 CALGARY CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2798
Mailing Address - Country:US
Mailing Address - Phone:734-905-6649
Mailing Address - Fax:734-369-3369
Practice Address - Street 1:5340 PLYMOUTH RD
Practice Address - Street 2:SUITE 208
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9341
Practice Address - Country:US
Practice Address - Phone:734-905-6649
Practice Address - Fax:734-369-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010621901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty