Provider Demographics
NPI:1952751232
Name:BOOTH, ALLISON
Entity Type:Individual
Prefix:
First Name:ALLISON
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 1:245 FM 1488 RD
Mailing Address - Street 2:1131
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3983
Mailing Address - Country:US
Mailing Address - Phone:214-562-1083
Mailing Address - Fax:
Practice Address - Street 1:245 FM 1488 RD
Practice Address - Street 2:1131
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-3983
Practice Address - Country:US
Practice Address - Phone:214-562-1083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional