Provider Demographics
NPI:1912779851
Name:BOOTHBY COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:BOOTHBY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTHBY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:712-251-5308
Mailing Address - Street 1:656 520TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTA
Mailing Address - State:IA
Mailing Address - Zip Code:51002-7535
Mailing Address - Country:US
Mailing Address - Phone:712-251-5308
Mailing Address - Fax:
Practice Address - Street 1:656 520TH ST
Practice Address - Street 2:
Practice Address - City:ALTA
Practice Address - State:IA
Practice Address - Zip Code:51002-7535
Practice Address - Country:US
Practice Address - Phone:712-251-5308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty