Provider Demographics
NPI:1972559110
Name:RATLIFF, RENEE (MED, LCPC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CONWAY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3112
Mailing Address - Country:US
Mailing Address - Phone:800-300-3108
Mailing Address - Fax:
Practice Address - Street 1:2229 5TH AVE
Practice Address - Street 2:SUITE 108
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:406-265-1313
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT740750OtherBC/BS PROVIDER #
MT0256394Medicaid