Provider Demographics
NPI:1942515325
Name:RATLIFF, TONYA JEAN (LPC, NCC, ACS)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:JEAN
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:LPC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45445 MOUND RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5178
Mailing Address - Country:US
Mailing Address - Phone:586-254-3663
Mailing Address - Fax:
Practice Address - Street 1:45445 MOUND RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-5178
Practice Address - Country:US
Practice Address - Phone:586-254-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010503101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor