Healthcare Provider Details

I. General information

NPI: 1386182392
Provider Name (Legal Business Name): ARIAL CARR-BOOTHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 SPLIT MOUNTAIN LN
SAN BERNARDINO CA
92407-5188
US

IV. Provider business mailing address

2934 SPLIT MOUNTAIN LN
SAN BERNARDINO CA
92407-5188
US

V. Phone/Fax

Practice location:
  • Phone: 951-852-9134
  • Fax:
Mailing address:
  • Phone: 951-852-9134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY36753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: