Individual
GLENN W RATLIFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
97 GREAT TEAYS BLVD STE 6, SCOTT DEPOT, WV 25560-9816
(304) 757-6999
(304) 201-5019
Mailing address
97 GREAT TEAYS BLVD STE 6, SCOTT DEPOT, WV 25560-9816
(304) 757-6999
(304) 201-5019
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1016
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356637318
—
WV
Enumeration date
06/28/2011
Last updated
06/10/2020
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