MEDICARE: SHIRLEY MARIE BOOTHE LCSW

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	1041C0700X	Clinical Social Worker	C9678	MS

General Provider Information

NPI Number	:	1841435708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY MARIE BOOTHE LCSW

Provider Business Mailing Address
First Line	:	302 BROOKS ST
Second Line	:
City	:	RALEIGH
State	:	MS
Zip	:	39153-6093
Country	:	US
Telephone Number	:	281-678-2463
Fax Number	:

Provider Business Practice Location Address
First Line	:	6106 RIVER MILL CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-6403
Country	:	US
Telephone Number	:	281-655-7118
Fax Number	:	281-655-7118

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

Provider Enumeration Date	:	12/08/2008
Last Update Date	:	12/07/2025

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