| Booth & Company | |
|
3240 Mallard Cove Ln Fort Wayne IN 46804-2883 | |
| (260) 755-5896 | |
| (260) 755-5927 |
| Full Name | Booth & Company |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 3240 Mallard Cove Ln, Fort Wayne, Indiana |
| Authorized Official Name and Position | Spencer Jenkins Booth (PRESIDENT) |
| Authorized Official Contact | 2607555896 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Booth & Company 3240 Mallard Cove Ln Fort Wayne IN 46804-2883 Ph: (260) 755-5896 | Booth & Company 3240 Mallard Cove Ln Fort Wayne IN 46804-2883 Ph: (260) 755-5896 |
| NPI Number | 1679694327 |
|---|---|
| Provider Enumeration Date | 04/02/2007 |
| Last Update Date | 01/31/2014 |
| 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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