Provider Demographics
NPI:1053648501
Name:BOOKER, DARLA R (MA)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:R
Last Name:BOOKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155081
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76155-0081
Mailing Address - Country:US
Mailing Address - Phone:405-255-8122
Mailing Address - Fax:
Practice Address - Street 1:2615 LAKE POINT DR APT 816
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-8500
Practice Address - Country:US
Practice Address - Phone:405-255-8122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82145101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional