Provider Demographics
NPI:1215171319
Name:BOOTH, REGINE JUNE (BCBA)
Entity type:Individual
Prefix:
First Name:REGINE
Middle Name:JUNE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 CAMPUS CIRCLE DR E
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2712
Mailing Address - Country:US
Mailing Address - Phone:469-374-0700
Mailing Address - Fax:
Practice Address - Street 1:6301 CAMPUS CIRCLE DR E
Practice Address - Street 2:SUITE 100A
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2712
Practice Address - Country:US
Practice Address - Phone:469-374-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst