Healthcare Provider Details

I. General information

NPI: 1396362786
Provider Name (Legal Business Name): TRACY YARBROUGH RATLIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11020 AUDUBON DR
HAMMOND LA
70403-2683
US

IV. Provider business mailing address

11020 AUDUBON DR
HAMMOND LA
70403-2683
US

V. Phone/Fax

Practice location:
  • Phone: 985-516-6169
  • Fax:
Mailing address:
  • Phone: 985-516-6169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC8166
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: