Provider Demographics
NPI:1598235780
Name:BOOKER, JARIAH ANTOINE
Entity Type:Individual
Prefix:MR
First Name:JARIAH
Middle Name:ANTOINE
Last Name:BOOKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9852 CANNON WAY
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:CA
Mailing Address - Zip Code:95953-9658
Mailing Address - Country:US
Mailing Address - Phone:530-788-3703
Mailing Address - Fax:
Practice Address - Street 1:995 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GRIDLEY
Practice Address - State:CA
Practice Address - Zip Code:95948-2128
Practice Address - Country:US
Practice Address - Phone:530-846-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty