Provider Demographics
NPI:1386396513
Name:BOOTH, HEIDI NICHOLE (LPCC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:NICHOLE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33480 LIBERTY PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2670
Mailing Address - Country:US
Mailing Address - Phone:440-732-5252
Mailing Address - Fax:
Practice Address - Street 1:33480 LIBERTY PKWY
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-2670
Practice Address - Country:US
Practice Address - Phone:440-732-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2404005101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional