Provider Demographics
NPI:1609361385
Name:RATZLAFF, RANDAL (LCDC)
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:
Last Name:RATZLAFF
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 SPUR 156
Mailing Address - Street 2:
Mailing Address - City:WASKOM
Mailing Address - State:TX
Mailing Address - Zip Code:75692-9129
Mailing Address - Country:US
Mailing Address - Phone:903-687-2586
Mailing Address - Fax:
Practice Address - Street 1:670 SPUR 156
Practice Address - Street 2:
Practice Address - City:WASKOM
Practice Address - State:TX
Practice Address - Zip Code:75692-9129
Practice Address - Country:US
Practice Address - Phone:903-687-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12963101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)