Provider Demographics
NPI:1710253513
Name:BOOTH, MOLLIE
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 LAKESIDE CT
Mailing Address - Street 2:#101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4829
Mailing Address - Country:US
Mailing Address - Phone:775-786-6880
Mailing Address - Fax:775-786-6899
Practice Address - Street 1:3500 LAKESIDE CT
Practice Address - Street 2:#101
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4829
Practice Address - Country:US
Practice Address - Phone:775-786-6880
Practice Address - Fax:775-786-6899
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)