Provider Demographics
NPI:1699658658
Name:GBOKEDE, TAGNON YANNE ELSIE GLA (RBT)
Entity type:Individual
Prefix:
First Name:TAGNON YANNE
Middle Name:ELSIE GLA
Last Name:GBOKEDE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8717 YVONNE COURT WAY
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3945
Mailing Address - Country:US
Mailing Address - Phone:443-653-9562
Mailing Address - Fax:
Practice Address - Street 1:7090 SAMUEL MORSE DR STE 100-300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3442
Practice Address - Country:US
Practice Address - Phone:855-935-3691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-25-455316106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician