MEDICARE: KAYE B RATZLAFF, LPC, PLLC

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	17718	TX

General Provider Information

NPI Number	:	1679807960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAYE B RATZLAFF, LPC, PLLC

Provider Business Mailing Address
First Line	:	108 WAIN DR
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75604-1231
Country	:	US
Telephone Number	:	903-232-8900
Fax Number	:	903-236-8510

Provider Business Practice Location Address
First Line	:	108 WAIN DR
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75604-1231
Country	:	US
Telephone Number	:	903-232-8900
Fax Number	:	903-236-8510

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KAYE B RATZLAFF
Credential	:	LPC
Telephone Number	:	903-232-8900

Provider Enumeration Date	:	09/20/2009
Last Update Date	:	09/20/2009

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