Provider Demographics
NPI:1154117182
Name:TAYLOR, TENIKA RA'SHA
Entity type:Individual
Prefix:
First Name:TENIKA
Middle Name:RA'SHA
Last Name:TAYLOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 MIRACLE STRIP PKWY SW STE 38
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5264
Mailing Address - Country:US
Mailing Address - Phone:850-374-3529
Mailing Address - Fax:850-807-5260
Practice Address - Street 1:348 MIRACLE STRIP PKWY SW STE 38
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5264
Practice Address - Country:US
Practice Address - Phone:850-374-3529
Practice Address - Fax:850-807-5260
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst