Provider Demographics
NPI:1053530501
Name:BOOTHCOUNSEL, PLLC
Entity type:Organization
Organization Name:BOOTHCOUNSEL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:972-980-3919
Mailing Address - Street 1:15150 PRESTON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4871
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15150 PRESTON RD STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4871
Practice Address - Country:US
Practice Address - Phone:972-980-3919
Practice Address - Fax:972-980-3921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18202261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0008KMOtherBLUE CROSS PPO
TX83746LOtherBLUE CHOICE