Provider Demographics
NPI:1396164596
Name:RENEE H. RATLIFF
Entity type:Organization
Organization Name:RENEE H. RATLIFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:H
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MED LCPC
Authorized Official - Phone:406-265-6743
Mailing Address - Street 1:2229 5TH AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-5217
Mailing Address - Country:US
Mailing Address - Phone:406-265-6743
Mailing Address - Fax:406-265-1312
Practice Address - Street 1:2229 5TH AVE STE 108
Practice Address - Street 2:
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:406-265-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1032101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0256394Medicaid
MT6961852OtherCERIDIAN
MT740750OtherBC/BS