Provider Demographics
NPI:1972295301
Name:BOOTH, ARNOLD LYDELL (COUNSELOR)
Entity type:Individual
Prefix:
First Name:ARNOLD
Middle Name:LYDELL
Last Name:BOOTH
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1496 N BEALE RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-6205
Mailing Address - Country:US
Mailing Address - Phone:530-749-8640
Mailing Address - Fax:
Practice Address - Street 1:1496 N BEALE ROAD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-6205
Practice Address - Country:US
Practice Address - Phone:530-749-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI280000919101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty