Provider Demographics
NPI:1841363066
Name:RATZLAFF, KAYE BUTLER (LPC)
Entity type:Individual
Prefix:MRS
First Name:KAYE
Middle Name:BUTLER
Last Name:RATZLAFF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 868
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-0868
Mailing Address - Country:US
Mailing Address - Phone:903-232-8900
Mailing Address - Fax:903-232-1830
Practice Address - Street 1:1800 JUDSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4708
Practice Address - Country:US
Practice Address - Phone:903-232-8900
Practice Address - Fax:903-232-1830
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17718101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17718OtherLPC LICENSING #
TX7100LCOtherBCBS OF TX.