MEDICARE: CONSTANCE B. RATCLIFF M.S. T-LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1943	TN

General Provider Information

NPI Number	:	1033257969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE B. RATCLIFF M.S. T-LPC

Provider Business Mailing Address
First Line	:	448 OCOEE CIR
Second Line	:
City	:	OCOEE
State	:	TN
Zip	:	37361-3632
Country	:	US
Telephone Number	:	423-338-9434
Fax Number	:

Provider Business Practice Location Address
First Line	:	2292 CHAMBLISS AVE NW
Second Line	:	SUITE C-2
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3862
Country	:	US
Telephone Number	:	423-479-5672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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