Healthcare Provider Details

I. General information

NPI: 1386508224
Provider Name (Legal Business Name): SHELBY BOOTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3129 KINGSLEY DR STE 840
PEARLAND TX
77584-8508
US

IV. Provider business mailing address

1466 IVY PARK TER APT 1230
PEARLAND TX
77047-0057
US

V. Phone/Fax

Practice location:
  • Phone: 281-818-6758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number100622
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: