Eileen M Booth, PHD
Individual provider Active NPI Clinical Psychologist · Provo, UT
NPI 1285651968 · NPPES record last updated Jun 15, 2026
Key facts
- NPI
- 1285651968
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 116525-2501 (UT)
- Practice address
- 395 W Cougar Blvd Ste 601
Provo, UT 84604-3331 - Phone
- (801) 357-7525
- Fax
- (801) 357-7191
- NPI assigned
- Jul 17, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Ihc Health Services Inc
Practice addresses (Care Compare)
395 W Bulldog Blvd
Provo, UT 84604-3331
700 S Hwy 99
Suite 3
Fillmore, UT 84631-5137
Phone (801) 357-4600
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040722000226 | UT | Practitioner - Clinical Psychologist | 0648250597 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1165252501 | UT | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ihc Health Services Inc | Current |
Accepting new patients | |
| Ihc Health Services Inc | Current | Accepting new patients |
Locations
1034 N 500 W
Provo, UT 84604
Phone (801) 362-4119
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 116525-2501 | UT | Yes |
Addresses
Primary practice location
395 W Cougar Blvd Ste 601
Provo, UT 84604-3331
Mailing address
PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 357-7525
Other practice location 1
1034 N 500 W
Provo, UT 84604-3380
Phone (801) 357-7850
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRReguest_Service | Other | Bluemark LLC / Office Ally |
Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.