Healthcare Provider Details

I. General information

NPI: 1750840898
Provider Name (Legal Business Name): TARYN R. BOOTH PH.D, LPC, CRC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 GARNERS FERRY RD BLDG 1
COLUMBIA SC
29209-1445
US

IV. Provider business mailing address

6311 GARNERS FERRY RD BLDG 1
COLUMBIA SC
29209-1445
US

V. Phone/Fax

Practice location:
  • Phone: 803-216-3695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number901985
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number001191124
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12423
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: