Healthcare Provider Details

I. General information

NPI: 1538958525
Provider Name (Legal Business Name): MENTAL HEALTH RATLIFF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3497 FAIRWAY CIR
SPANISH FORK UT
84660-8401
US

IV. Provider business mailing address

3497 FAIRWAY CIR
SPANISH FORK UT
84660-8401
US

V. Phone/Fax

Practice location:
  • Phone: 725-292-7014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEREMY RATLIFF
Title or Position: NURSE PRACTITIONER
Credential: DNP, PMHNP-C, FNP-C
Phone: 725-292-7014