Boothe, Krystal Marie

Boothe, Krystal Marie is an sole proprietor health care provider with primary practice located at 1050 Lakes Dr , West Covina CA 91790-2924. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Boothe, Krystal Marie can be contacted via phone (310) 621-0150.

Contact Information

Primary practice address
1050 Lakes Dr West Covina CA 91790-2924
Phone: (310) 621-0150
Fax: (661) 727-0006
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X LCSW71811 California

Profile Details

NPI number 1043488414
LBN Legal business name Boothe, Krystal Marie
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 19th, 2008
Last updated Feb 25th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043488414 NPPES
California MEDICAID 99999999999999
California Other 9999999999

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