Provider Demographics
NPI:1033001771
Name:BOOCO LLC
Entity type:Organization
Organization Name:BOOCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-595-1099
Mailing Address - Street 1:60 SCARLET ST
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-3566
Mailing Address - Country:US
Mailing Address - Phone:601-595-1099
Mailing Address - Fax:
Practice Address - Street 1:60 SCARLET ST
Practice Address - Street 2:
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39475-3566
Practice Address - Country:US
Practice Address - Phone:601-595-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW.09926220OtherLCSW
MSC5583OtherLCSW