Provider Demographics
NPI:1174852677
Name:CONSCIOUS HEALING THERAPIES, LLC
Entity Type:Organization
Organization Name:CONSCIOUS HEALING THERAPIES, LLC
Other - Org Name:MELISSA RATLIFF, LCSW
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:662-841-8020
Mailing Address - Street 1:302 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4853
Mailing Address - Country:US
Mailing Address - Phone:662-841-8020
Mailing Address - Fax:662-841-8021
Practice Address - Street 1:302 S SPRING ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4853
Practice Address - Country:US
Practice Address - Phone:662-841-8020
Practice Address - Fax:662-841-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC57721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05281357Medicaid