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NPI Code Detail

MEDICARE: ERIN BOOHER M.ED., LPC, NCC

MEDICARE: ERIN BOOHER M.ED., LPC, NCC
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
1101YP2500XProfessional Counselor69054TX

General Provider Information

NPI Number : 1548713654
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN BOOHER M.ED., LPC, NCC
Provider Business Mailing Address
First Line : 15512 PIONEER BLUFF TRL
Second Line :
City : ROANOKE
State : TX
Zip : 76262-1797
Country : US
Telephone Number : 817-567-3483
Fax Number :
Provider Business Practice Location Address
First Line : 1706 ENDERLY PL
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4122
Country : US
Telephone Number : 817-688-4750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2016
Last Update Date : 07/26/2016

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