Doctor Name: | MR. TYSON BENJAMIN RATZLAFF |
NPI Number: | 1376875377 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 4255 |
Business Practice Address: | 705 W Main St Tishomingo, OK - 734601734 |
Business Phone Number: | 5803713799 |
Business Fax Number: | |
Mailing Address: | 2355 E Cedar Ridge Rd, TISHOMINGO |
State: | OK |
Postal Code: | 734604045 |
Phone Number: | 5802728012 |
Fax Number: | 5803712056 |
NPI Enumeration Date: | 02/02/2010 |
NPI Last Update Date: | 02/02/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 4255 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |