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Organization
GRANT BOOTH PA DBA BOOTH THERAPY
Active
Organization
GRANT BOOTH PA DBA BOOTH THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRANT EDWARD BOOTH MSW, LICSW, ACSW (THERAPIST/CLINICAL SOCIAL WORKER)
(651) 690-1542
Entity
Organization
Contact information
Practice address
1499 LINCOLN AVE, SAINT PAUL, MN 55105-2236
(651) 690-1542
Mailing address
1499 LINCOLN AVE, SAINT PAUL, MN 55105-2236
(651) 690-1542
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
07/19/2017
Last updated
07/21/2022
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