Provider Demographics
NPI:1720437940
Name:BOOTH, TAMI ELAINE (LMHC)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:ELAINE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 W JEFFERSON BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6800
Mailing Address - Country:US
Mailing Address - Phone:260-481-2700
Mailing Address - Fax:260-481-2838
Practice Address - Street 1:4630 W JEFFERSON BLVD STE 3
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6800
Practice Address - Country:US
Practice Address - Phone:260-572-0510
Practice Address - Fax:260-233-9464
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN39004512A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health