Provider Demographics
NPI:1942438106
Name:RATZ, TAMMY (LMSW, LPC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:RATZ
Suffix:
Gender:F
Credentials:LMSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-8601
Mailing Address - Country:US
Mailing Address - Phone:517-795-9042
Mailing Address - Fax:
Practice Address - Street 1:313 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MI
Practice Address - Zip Code:49230-8601
Practice Address - Country:US
Practice Address - Phone:517-795-9042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002947104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1063466274Medicaid