Provider Demographics
NPI:1972565430
Name:RATLIFF, MARTHA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1009
Mailing Address - Country:US
Mailing Address - Phone:970-472-1207
Mailing Address - Fax:970-493-1305
Practice Address - Street 1:1740 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1009
Practice Address - Country:US
Practice Address - Phone:970-472-1207
Practice Address - Fax:970-493-1305
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO991944101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC356858Medicare PIN