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NPI Code Detail

MEDICARE: MISS CHRYSTAL MARIE BOOTHE MA, BCBA, LBA

MEDICARE: MISS CHRYSTAL MARIE BOOTHE MA, BCBA, LBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst0133003687VA

General Provider Information

NPI Number : 1538832274
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS CHRYSTAL MARIE BOOTHE MA, BCBA, LBA
Provider Business Mailing Address
First Line : 202 N WASHINGTON AVE
Second Line :
City : PULASKI
State : VA
Zip : 24301-5022
Country : US
Telephone Number : 540-994-2550
Fax Number :
Provider Business Practice Location Address
First Line : 202 N WASHINGTON AVE
Second Line :
City : PULASKI
State : VA
Zip : 24301-5022
Country : US
Telephone Number : 540-994-2550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2021
Last Update Date : 06/21/2024

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