Provider Demographics
NPI:1396362786
Name:RATLIFF, TRACY YARBROUGH
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:YARBROUGH
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11020 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-2683
Mailing Address - Country:US
Mailing Address - Phone:985-516-6169
Mailing Address - Fax:
Practice Address - Street 1:11020 AUDUBON DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-2683
Practice Address - Country:US
Practice Address - Phone:985-516-6169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
LAPLC8166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0000000Medicaid