Individual
SAM BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
9329 ILLINOIS RD, FORT WAYNE, IN 46804-5796
(260) 444-6045
Mailing address
9329 ILLINOIS RD, FORT WAYNE, IN 46804-5796
(260) 444-6045
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/27/2025
Last updated
10/27/2025
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