Organization
BOOTH & COMPANY, INC.
Active
Other names
Booth & Company, Great Lakes Psychological Assessment
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SPENCER JENKINS BOOTH PSY.D., HSPP (PRESIDENT)
(260) 417-4885
Entity
Organization
Contact information
Practice address
9329 ILLINOIS RD, FORT WAYNE, IN 46804-5796
(260) 755-5896
(260) 755-5927
Mailing address
9329 ILLINOIS RD, FORT WAYNE, IN 46804-5796
(260) 755-5896
(260) 755-5927
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041340A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200311450
—
IN
Enumeration date
04/02/2007
Last updated
10/01/2024
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