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General NPI Number Information
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NPI Number | 1043488414
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Entity Type | Individual
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Provider Name | KRYSTAL MARIE BOOTHE LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 117 E COLORADO BLVD
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City | PASADENA
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State | CA
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Zip | 91105-1938
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Country | US
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Telephone | 661-402-1545
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Fax | 661-727-0006
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Provider Business Mailing Address
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Address Line | 1308 ISLAND VISTA DR
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City | ARLINGTON
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State | TX
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Zip | 76005-1375
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Country | US
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Telephone | 310-621-0150
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Fax | 661-727-0006
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW71811
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License Number State | CA
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