Provider Demographics
NPI:1043967573
Name:BOOTHE, SHARON I (CADC I)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:I
Last Name:BOOTHE
Suffix:
Gender:F
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0160
Mailing Address - Country:US
Mailing Address - Phone:541-966-9830
Mailing Address - Fax:
Practice Address - Street 1:46314 TIMINE WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-9417
Practice Address - Country:US
Practice Address - Phone:541-966-9830
Practice Address - Fax:541-240-8754
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19-07-24405300000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No405300000XOther Service ProvidersPrevention Professional