Provider Demographics
NPI:1588867758
Name:BOOHER, CARRIE S (PHD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:S
Last Name:BOOHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9508
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37940-0508
Mailing Address - Country:US
Mailing Address - Phone:865-351-2067
Mailing Address - Fax:
Practice Address - Street 1:9111 CROSS PARK DR STE D200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4521
Practice Address - Country:US
Practice Address - Phone:865-351-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2613103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1505990Medicaid