| Doctor Name: | DR. WILLIAM S. BOOM |
| NPI Number: | 1952427544 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 6301011209 |
| Business Practice Address: | 172 N Cedar St Imlay City, MI - 484441122 |
| Business Phone Number: | 8107240598 |
| Business Fax Number: | |
| Mailing Address: | 2063 Cole Rd, LAKE ORION |
| State: | MI |
| Postal Code: | 483622105 |
| Phone Number: | 8107212273 |
| Fax Number: | |
| NPI Enumeration Date: | 03/22/2007 |
| NPI Last Update Date: | 08/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6301011209 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |