Provider Demographics
NPI:1407689797
Name:MCDOWELL, TIQUILLA ANQUENETTE (RBT)
Entity type:Individual
Prefix:
First Name:TIQUILLA
Middle Name:ANQUENETTE
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 MS HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:HOLCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:38940-9111
Mailing Address - Country:US
Mailing Address - Phone:662-809-4827
Mailing Address - Fax:
Practice Address - Street 1:4036 BONITA DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7240
Practice Address - Country:US
Practice Address - Phone:662-809-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-308394106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician