Provider Demographics
NPI:1538524244
Name:BOOTHROYD, PAUL R JR (LPC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:R
Last Name:BOOTHROYD
Suffix:JR
Gender:M
Credentials:LPC
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Mailing Address - Street 1:5100 EASTMAN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-832-0191
Mailing Address - Fax:989-486-9413
Practice Address - Street 1:5100 EASTMAN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-832-0191
Practice Address - Fax:989-486-9413
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2024-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI6401013357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional