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General NPI Number Information
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NPI Number | 1619019502
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Entity Type | Individual
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Provider Name | MR. JASON LEWIS RATLIFF
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 09/08/2008
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Provider Practice Location Address
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Address Line | 404 HOLSTON DR
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City | GREENEVILLE
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State | TN
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Zip | 37743-3126
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Country | US
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Telephone | 423-638-4171
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Fax |
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Provider Business Mailing Address
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Address Line | 257 HILL TOP CIR
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City | BLUFF CITY
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State | TN
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Zip | 37618-1632
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Country | US
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Telephone | 423-366-3177
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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