Provider Demographics
NPI:1407694607
Name:RATLIFF, LA-RISHA RESHAWN (LMHC, LCAC)
Entity type:Individual
Prefix:
First Name:LA-RISHA
Middle Name:RESHAWN
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:LMHC, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 CAMBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-5514
Mailing Address - Country:US
Mailing Address - Phone:317-440-2112
Mailing Address - Fax:
Practice Address - Street 1:3815 RIVER CROSSING PKWY STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-7766
Practice Address - Country:US
Practice Address - Phone:646-941-7645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001317A101YA0400X
IN39002258A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)