Provider Demographics
NPI:1902368095
Name:DUSTIN RATLIFF, LCPC
Entity Type:Organization
Organization Name:DUSTIN RATLIFF, LCPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-781-3055
Mailing Address - Street 1:2229 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-5217
Mailing Address - Country:US
Mailing Address - Phone:406-265-6743
Mailing Address - Fax:
Practice Address - Street 1:2229 5TH AVE
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-5217
Practice Address - Country:US
Practice Address - Phone:406-265-6743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health