Provider Demographics
NPI:1942799051
Name:RATLIFFE, EILEEN
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:RATLIFFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HORIZONS
Other - Middle Name:
Other - Last Name:UNLIMITED.LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85211-0930
Mailing Address - Country:US
Mailing Address - Phone:480-358-8956
Mailing Address - Fax:
Practice Address - Street 1:59 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-1625
Practice Address - Country:US
Practice Address - Phone:480-358-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47-4379249101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ47-4379249OtherOTHER INSURERS
AZ47-4379249Medicaid