Provider Demographics
NPI:1164946240
Name:BOOTH, ELISHA DAWN (LPC)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:DAWN
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ELISHA
Other - Middle Name:DAWN
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1755 N WESTGATE DR STE 280
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7176
Mailing Address - Country:US
Mailing Address - Phone:208-724-9524
Mailing Address - Fax:
Practice Address - Street 1:1755 N WESTGATE DR STE 280
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7176
Practice Address - Country:US
Practice Address - Phone:208-724-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health