MEDICARE: RAQUEPAW ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2-4154	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4626769	OTHER	TX	AETNA BEHAVIORAL HEALTH
2	00000042JN	OTHER	TX	BLUECROSS BLUESHIELD
3	144401000	OTHER	TX	MAGELLAN BEHAVIORAL HEALT
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	225414713	OTHER	TX	UNITED BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1649252917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAQUEPAW ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	3400 BISSONNET ST STE 280
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-2192
Country	:	US
Telephone Number	:	713-909-4841
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 BISSONNET ST STE 280
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-2192
Country	:	US
Telephone Number	:	713-909-4841
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. JAYNE RAQUEPAW
Credential	:	PH.D.
Telephone Number	:	713-960-8112

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	08/27/2022

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Directions to “RAQUEPAW ENTERPRISES, INC. ” Practice Location

Language	Start Address	Practice Location

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