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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