| Doctor Name: | TAMECO BOOTH |
| NPI Number: | 1104204395 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 043.117905 |
| Business Practice Address: | 2615 Edwards St Alton, IL - 620023915 |
| Business Phone Number: | 6184622331 |
| Business Fax Number: | 6184622504 |
| Mailing Address: | 2615 Edwards St, ALTON |
| State: | IL |
| Postal Code: | 620023915 |
| Phone Number: | 6184622331 |
| Fax Number: | 6184622504 |
| NPI Enumeration Date: | 05/08/2015 |
| NPI Last Update Date: | 05/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | 043.117905 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |