Provider Demographics
NPI:1588672778
Name:BOOTH, MICHAEL D (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:BOOTH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15150 PRESTON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4877
Mailing Address - Country:US
Mailing Address - Phone:972-980-3919
Mailing Address - Fax:972-980-3921
Practice Address - Street 1:15150 PRESTON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4877
Practice Address - Country:US
Practice Address - Phone:972-980-3919
Practice Address - Fax:972-980-3921
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX18202101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83746LOtherBLUE CROSS BLUE SHIELD
TX919832OtherUSA MANAGED CARE