Booth & Company | |
9329 Illinois Rd Fort Wayne IN 46804-5796 | |
(260) 755-5896 | |
(260) 755-5927 |
Full Name | Booth & Company |
---|---|
Speciality | Psychologist - Clinical |
Location | 9329 Illinois Rd, Fort Wayne, Indiana |
Authorized Official Name and Position | Spencer Jenkins Booth (PRESIDENT) |
Authorized Official Contact | 2604174885 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Booth & Company 9329 Illinois Rd Fort Wayne IN 46804-5796 Ph: (260) 755-5896 | Booth & Company 9329 Illinois Rd Fort Wayne IN 46804-5796 Ph: (260) 755-5896 |
NPI Number | 1679694327 |
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Provider Enumeration Date | 04/02/2007 |
Last Update Date | 10/01/2024 |
Certification Date | 10/01/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1679694327 | NPI | - | NPPES |
200311450 | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | 20041340A (Indiana) | Primary |
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