Provider Demographics
NPI:1467656959
Name:RAGLAND, JOHN GUERRANT (DMIN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GUERRANT
Last Name:RAGLAND
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4257 SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-1626
Mailing Address - Country:US
Mailing Address - Phone:256-461-8580
Mailing Address - Fax:256-772-9732
Practice Address - Street 1:600 GOVERNORS DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5128
Practice Address - Country:US
Practice Address - Phone:256-461-8580
Practice Address - Fax:256-772-9732
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLMFT 110106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist