Provider Demographics
NPI:1710168810
Name:RATLIFF-SORRELL, MELISSA CLYTEE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CLYTEE
Last Name:RATLIFF-SORRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:RATLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:324 TROY ST STE B
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4830
Mailing Address - Country:US
Mailing Address - Phone:662-841-8020
Mailing Address - Fax:662-841-8021
Practice Address - Street 1:324 TROY ST STE B
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4830
Practice Address - Country:US
Practice Address - Phone:662-841-8020
Practice Address - Fax:662-841-8021
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC57721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05281357Medicaid