Healthcare Provider Details

I. General information

NPI: 1003723164
Provider Name (Legal Business Name): TRISHA RAQUE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 EASTMOOR DR APT 107
DENVER CO
80237-2321
US

IV. Provider business mailing address

7250 EASTMOOR DR APT 107
DENVER CO
80237-2321
US

V. Phone/Fax

Practice location:
  • Phone: 704-287-6399
  • Fax:
Mailing address:
  • Phone: 704-287-6399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY.004814
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: