1871243808 NPI number — COGNITIVE GROWTH MENTAL HEALTH

Table of content: JOHN T RATLIFF MD (NPI 1679545610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871243808 NPI number — COGNITIVE GROWTH MENTAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COGNITIVE GROWTH MENTAL HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871243808
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 BRIDGEPORT WAY W STE A
Provider Second Line Business Mailing Address:
#302
Provider Business Mailing Address City Name:
UNIVERSITY PLACE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98466-4495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-701-1962
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6314 19TH ST W STE 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FIRCREST
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-6223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-701-1962
Provider Business Practice Location Address Fax Number:
866-434-6268
Provider Enumeration Date:
03/24/2022

Additional Information

Authorized Official

Authorized Official Last Name:
GROETKEN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
CECIL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
206-701-1962

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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