Mellisa Lau Booth

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6369 Issued in LA

Practice address

2829 4TH Ave
Lake Charles, LA 70601-7887

Phone

(337) 477-7091

Fax

(337) 474-4552

NPI assigned

Jun 14, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• MMG Archer Institute, LLC

  • Psychiatry Physician
  • Lake Charles, LA
  • NPI 1952897688
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1154851038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2829 4TH AVE",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017887",
            "telephone_number": "337-477-7091",
            "fax_number": "337-474-4552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2829 4TH AVE",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017887",
            "telephone_number": "337-477-7091",
            "fax_number": "337-474-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "MELLISA",
        "middle_name": "LAU",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-14",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "LA",
            "license": "6369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1063569648",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1551228",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monica Lynn Bonin, M.S., LAC, AADC
• Casey N Bonsall
• Stephen P Booker, MD
• Roberta Boone, PT
• Brantley Booth, PMHNP
• Charlotte Martia Bordelon
• Deborah Bordelon, LPC
• Barry Stephen Bordenave, M.D.
• Bruce P. Bordlee, M.D.
• Boreing Vision Clinic Inc

• Mental Health Counselor in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Mental Health Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.