Healthcare Provider Details

I. General information

NPI: 1184340168
Provider Name (Legal Business Name): CHERYL D RATLIFF PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 EXECUTIVE WOODS DR STE 100
LINCOLN NE
68512-9647
US

IV. Provider business mailing address

8525 EXECUTIVE WOODS DR STE 100
LINCOLN NE
68512-9647
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-2218
  • Fax: 402-489-3666
Mailing address:
  • Phone: 402-489-2218
  • Fax: 402-489-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13118
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: