Provider Demographics
NPI:1356160592
Name:ROQUE, JAIME ANTONIO (RBT)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:ANTONIO
Last Name:ROQUE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8914 OPPER LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-3468
Mailing Address - Country:US
Mailing Address - Phone:346-366-0071
Mailing Address - Fax:
Practice Address - Street 1:8914 OPPER LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-3468
Practice Address - Country:US
Practice Address - Phone:346-366-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24-340258106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician