Provider Demographics
NPI:1780494591
Name:BOOTH, LAURA MICHELLE (RMHCI)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 FENTRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1214
Mailing Address - Country:US
Mailing Address - Phone:321-209-2973
Mailing Address - Fax:
Practice Address - Street 1:728 FENTRESS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1214
Practice Address - Country:US
Practice Address - Phone:321-209-2973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25872101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health