Individual
EILEEN M BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-7850
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 357-7850
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1165252501
UT
Other
Enumeration date
07/17/2006
Last updated
01/18/2013
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