Provider Demographics
NPI:1366221582
Name:RAYFORD, TIRRA RONETTA
Entity type:Individual
Prefix:
First Name:TIRRA
Middle Name:RONETTA
Last Name:RAYFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611-8492
Mailing Address - Country:US
Mailing Address - Phone:901-229-8920
Mailing Address - Fax:
Practice Address - Street 1:169 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:BYHALIA
Practice Address - State:MS
Practice Address - Zip Code:38611-8492
Practice Address - Country:US
Practice Address - Phone:901-229-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14486104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker