Provider Demographics
NPI:1558641068
Name:BOOTH, TRACI (LMSW)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 TUTTLE CREEK BLVD LOT 341
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-7109
Mailing Address - Country:US
Mailing Address - Phone:785-341-5985
Mailing Address - Fax:
Practice Address - Street 1:3000 TUTTLE CREEK BLVD LOT 341
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-7109
Practice Address - Country:US
Practice Address - Phone:785-341-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7780171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator