Provider Demographics
NPI:1225091515
Name:RATLIFF, RICHARD GLENN (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GLENN
Last Name:RATLIFF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 14TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5310
Mailing Address - Country:US
Mailing Address - Phone:303-440-0072
Mailing Address - Fax:303-530-0419
Practice Address - Street 1:1919 14TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5310
Practice Address - Country:US
Practice Address - Phone:303-440-0072
Practice Address - Fax:303-530-0419
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO330103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07003304Medicaid
COC93816Medicare ID - Type Unspecified