MEDICARE: PATRICK ROBERT BOOTH M.S.

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	101Y00000X	Counselor
2	106S00000X	Behavior Technician	RBT-16-16491	NV
3	225400000X	Rehabilitation Practitioner		NV
4	103K00000X	Behavior Analyst	1-19-35356	NV

General Provider Information

NPI Number	:	1639434582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK ROBERT BOOTH M.S.

Provider Business Mailing Address
First Line	:	7261 W CHARLESTON BLVD
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1636
Country	:	US
Telephone Number	:	702-396-0101
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 SPENCER ST STE 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5250
Country	:	US
Telephone Number	:	702-799-9710
Fax Number	:

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

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	07/07/2022

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