Healthcare Provider Details

I. General information

NPI: 1780697524
Provider Name (Legal Business Name): LYNNORA ANN RATLIFF PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD PSYCHOLOGY (116B)
DALLAS TX
75216-7167
US

IV. Provider business mailing address

6136 RAVENDALE LN
DALLAS TX
75214-2311
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-0534
  • Fax:
Mailing address:
  • Phone: 214-857-0534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number24566
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: