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General NPI Number Information
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NPI Number | 1598276438
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Entity Type | Organization
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Legal Business Name | BOOTH PSYCHOLOGICAL SOLUTIONS, PLLC
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 10/18/2017
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Provider Practice Location Address
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Address Line | 13945 W WAINWRIGHT DR STE 106
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City | BOISE
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State | ID
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Zip | 83713-1925
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Country | US
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Telephone | 208-377-1131
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Fax | 208-908-7129
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Provider Business Mailing Address
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Address Line | 10 CREEKSIDE CT
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City | GARDEN VALLEY
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State | ID
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Zip | 83622-5294
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Country | US
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Telephone | 208-377-1131
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | RAYDELL J BOOTH
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Credential | PH.D.
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Telephone | 208-377-1131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | PSY-211
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License Number State | ID
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