Provider Demographics
NPI:1457713562
Name:SIDDIQUI, RAAHAT
Entity type:Individual
Prefix:
First Name:RAAHAT
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 TULIP CT
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-2743
Mailing Address - Country:US
Mailing Address - Phone:714-723-1680
Mailing Address - Fax:
Practice Address - Street 1:1675 REPUBLIC PKWY STE 104
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6902
Practice Address - Country:US
Practice Address - Phone:214-817-2457
Practice Address - Fax:214-393-5875
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-16-6975103K00000X
CA1-22-59383103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst