MEDICARE: DARLA R. BOOKER M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	82145	TX

General Provider Information

NPI Number	:	1053648501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLA R. BOOKER M.A.

Provider Business Mailing Address
First Line	:	PO BOX 155081
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76155-0081
Country	:	US
Telephone Number	:	405-255-8122
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 LAKE POINT DR APT 816
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-8500
Country	:	US
Telephone Number	:	405-255-8122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	08/21/2023

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