Provider Demographics
NPI:1871319947
Name:TENEQUER, JAVAN
Entity type:Individual
Prefix:
First Name:JAVAN
Middle Name:
Last Name:TENEQUER
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 1:401 S COLTRANE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6722
Mailing Address - Country:US
Mailing Address - Phone:508-318-9415
Mailing Address - Fax:405-999-4998
Practice Address - Street 1:401 S COLTRANE RD STE 260
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6722
Practice Address - Country:US
Practice Address - Phone:508-318-9415
Practice Address - Fax:405-999-4998
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty