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NPI Code Detail

MEDICARE: MR. MATTHEW BOOTH

MEDICARE: MR. MATTHEW BOOTH
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
1101YM0800XMental Health Counselor3173CA

General Provider Information

NPI Number : 1255719464
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW BOOTH
Provider Business Mailing Address
First Line : 1585 KANSAS AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93405-7604
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1585 KANSAS AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93405-7604
Country : US
Telephone Number : 619-300-2968
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2015
Last Update Date : 12/17/2025

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Directions to “ MR. MATTHEW BOOTH ” Practice Location

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