Provider Demographics
NPI:1649252917
Name:RAQUEPAW ENTERPRISES, INC.
Entity type:Organization
Organization Name:RAQUEPAW ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAQUEPAW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:713-960-8112
Mailing Address - Street 1:3400 BISSONNET ST STE 280
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2192
Mailing Address - Country:US
Mailing Address - Phone:713-909-4841
Mailing Address - Fax:
Practice Address - Street 1:3400 BISSONNET ST STE 280
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2192
Practice Address - Country:US
Practice Address - Phone:713-909-4841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2022-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-4154103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4626769OtherAETNA BEHAVIORAL HEALTH
TX00000042JNOtherBLUECROSS BLUESHIELD
TX144401000OtherMAGELLAN BEHAVIORAL HEALT
TX099272902Medicaid
TX225414713OtherUNITED BEHAVIORAL HEALTH