Provider Demographics
NPI:1053184168
Name:BOOKER, TROY JAI-SHUA (TB)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:JAI-SHUA
Last Name:BOOKER
Suffix:
Gender:M
Credentials:TB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 ROSETTA DR
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-3454
Mailing Address - Country:US
Mailing Address - Phone:404-438-9386
Mailing Address - Fax:
Practice Address - Street 1:201 SAINT CHARLES AVE STE 2500
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70170-2500
Practice Address - Country:US
Practice Address - Phone:877-418-2978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician