Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2-3871 | TX |
Y | 103T00000X | Psychologist | 2-3871 | TX |
NPI | 1003815341 |
---|---|
Provider Name | Dr. Michael J Ratheal |
First Address | Lubbock, TX 79414-2000 |
Second Address | Lubbock, TX 79414-2000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G16C | BC/BS (01) | TX |