Provider Demographics
NPI:1932739406
Name:THORNS, TAQUITTA REANEE
Entity Type:Individual
Prefix:
First Name:TAQUITTA
Middle Name:REANEE
Last Name:THORNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6084 APPLE TREE DR STE 10
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-0305
Mailing Address - Country:US
Mailing Address - Phone:901-299-5619
Mailing Address - Fax:
Practice Address - Street 1:6084 APPLE TREE DR STE 10
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-0305
Practice Address - Country:US
Practice Address - Phone:901-299-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No1744R1102XOther Service ProvidersSpecialistResearch Study
No174H00000XOther Service ProvidersHealth Educator
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness