Provider Demographics
NPI:1144074022
Name:SKINNER, RENIQUA SHAYE (MFT)
Entity type:Individual
Prefix:
First Name:RENIQUA
Middle Name:SHAYE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:RENIQUA
Other - Middle Name:SHAYE
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:1818 BENDING GREEN DR
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-2908
Mailing Address - Country:US
Mailing Address - Phone:903-530-8570
Mailing Address - Fax:
Practice Address - Street 1:130 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3220
Practice Address - Country:US
Practice Address - Phone:281-508-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204199106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist