Provider Demographics
NPI:1174172597
Name:SARA BOOTH COUNSELING LLC
Entity type:Organization
Organization Name:SARA BOOTH COUNSELING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:FRANACES
Authorized Official - Middle Name:E
Authorized Official - Last Name:VOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-241-0763
Mailing Address - Street 1:PO BOX 2192
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-0192
Mailing Address - Country:US
Mailing Address - Phone:440-241-0763
Mailing Address - Fax:440-801-1463
Practice Address - Street 1:7225 E FIRELANDS DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2450
Practice Address - Country:US
Practice Address - Phone:440-241-0763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SARA BOOTH COUNSELING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-09
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty