Provider Demographics
NPI:1548713654
Name:BOOHER, ERIN (MED, LPC, NCC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BOOHER
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15512 PIONEER BLUFF TRL
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-1797
Mailing Address - Country:US
Mailing Address - Phone:817-567-3483
Mailing Address - Fax:
Practice Address - Street 1:1706 ENDERLY PL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4122
Practice Address - Country:US
Practice Address - Phone:817-688-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69054101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional