Provider Demographics
NPI:1932119575
Name:BOOTH, JANE ELIZABETH (PHD)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELIZABETH
Last Name:BOOTH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:ELIZABETH
Other - Last Name:BOOTH-LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:13201 NORTHWEST FWY STE 668
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-6237
Mailing Address - Country:US
Mailing Address - Phone:281-513-5311
Mailing Address - Fax:
Practice Address - Street 1:13201 NORTHWEST FWY STE 668
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-6237
Practice Address - Country:US
Practice Address - Phone:713-487-5882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32779103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4159261Medicaid