Provider Demographics
NPI:1457975252
Name:BOOTH, VICTORIA (LPA, LPC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LPA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10403 DEWEY EVE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5583
Mailing Address - Country:US
Mailing Address - Phone:713-419-7478
Mailing Address - Fax:
Practice Address - Street 1:17030 NANES DR STE 201
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2504
Practice Address - Country:US
Practice Address - Phone:281-415-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76071101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional