Booth, Spencer Jenkins

Booth, Spencer Jenkins is an individual health care provider with primary practice located at 6526 W Jefferson Blvd , Fort Wayne IN 46804-6206. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Booth, Spencer Jenkins can be contacted via phone (260) 417-4885.

Contact Information

Primary practice address
6526 W Jefferson Blvd Fort Wayne IN 46804-6206
Phone: (260) 417-4885
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 20041340A Indiana
Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities 103TM1800X

Profile Details

NPI number 1730495813
LBN Legal business name Booth, Spencer Jenkins
Credentials PSYD, HSPP
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 26th, 2010
Last updated Apr 26th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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