Individual
ANTHONY HOWARD BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LADC
Contact information
Practice address
1822 OAK ST, BRAINERD, MN 56401-3857
(612) 505-0768
Mailing address
411 FRONT ST, BRAINERD, MN 56401-3516
(612) 505-0768
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305975
MN
Other
Enumeration date
03/13/2023
Last updated
07/14/2023
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