DEREK BOOTH

LAFAYETTE, IN
NPI1568852986
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: IN  71005314B)
Enumeration Date2015-01-24
Last Update Date2015-01-24
Business Address
-- DEREK BOOTH
415 N 26TH ST SUITE 201
LAFAYETTE, IN 47904-2895
Phone number: 765-446-6577
Mailing Address
-- DEREK BOOTH
415 N 26TH ST SUITE 201
LAFAYETTE, IN 47904-2895
Phone number:
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