Provider Demographics
NPI:1306068051
Name:RAQUEPAW, JAYNE M (PHD)
Entity type:Individual
Prefix:DR
First Name:JAYNE
Middle Name:M
Last Name:RAQUEPAW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 BISSONNET ST
Mailing Address - Street 2:STE 280
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
Practice Address - Street 2:STE 280
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:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24154103TE1100X, 103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099272902Medicaid
TX099272902Medicaid