Active NPI
Travis Andrew Booth, MA, LCPC
- Professional Counselor
- Evanston, IL
National Provider Identifier
1730423393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.009981
- Practice address
- 1007 Church St
Suite 302
Evanston, IL 60201-3624 - Phone
- (847) 492-1938
- Fax
- (847) 423-5670
- NPI assigned
- Nov 20, 2012
- Last updated
- Mar 7, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.008592 | IL | |
| Professional Counselor | 101YP2500X | 180.009981 | IL | Primary |
Addresses
Primary practice location
1007 Church St
Suite 302
Evanston, IL 60201-3624
Mailing address
1007 Church St
Suite 302
Evanston, IL 60201-3624
Phone (847) 492-1938
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PHCP058737 | Other | IL | PHILADELPHIA INDEMNITY INSURANCE COMPANY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.008592 | IL | MD | Professional Counselor |
| 180.009981 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Springtree Counseling, P.C. | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Spring Tree Counseling
- Mental Health Counselor
- Evanston, IL
- NPI 1902911860
Professional
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457308800000",
"number": "1730423393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1007 CHURCH ST",
"address_2": "SUITE 302",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602013624",
"telephone_number": "847-492-1938",
"fax_number": "847-423-5670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1007 CHURCH ST",
"address_2": "SUITE 302",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602013624",
"telephone_number": "847-492-1938",
"fax_number": "847-423-5670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTH",
"first_name": "TRAVIS",
"middle_name": "ANDREW",
"credential": "MA, LCPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-11-20",
"last_updated": "2016-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.008592",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.009981",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHILADELPHIA INDEMNITY INSURANCE COMPANY",
"identifier": "PHCP058737",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.