Provider Demographics
NPI:1114249521
Name:BOOTS, TONYA ELAINE (MS LPC)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:ELAINE
Last Name:BOOTS
Suffix:
Gender:F
Credentials:MS LPC
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 95207
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-5207
Mailing Address - Country:US
Mailing Address - Phone:866-926-6552
Mailing Address - Fax:
Practice Address - Street 1:118 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3102
Practice Address - Country:US
Practice Address - Phone:580-214-0244
Practice Address - Fax:580-477-1212
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2856101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional