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NPI Code Detail

MEDICARE: MR. MICHAEL ALEXANDER BOOTH MFT

MEDICARE: MR. MICHAEL ALEXANDER BOOTH MFT
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 CounselorMFC43416CA

General Provider Information

NPI Number : 1871662007
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL ALEXANDER BOOTH MFT
Provider Business Mailing Address
First Line : 200 MICHIGAN AVE
Second Line :
City : VISTA
State : CA
Zip : 92084-5424
Country : US
Telephone Number : 760-726-4900
Fax Number : 760-631-0778
Provider Business Practice Location Address
First Line : 200 MICHIGAN AVE
Second Line :
City : VISTA
State : CA
Zip : 92084-5424
Country : US
Telephone Number : 760-726-4900
Fax Number : 760-631-0778
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 07/08/2007

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