Provider Demographics
NPI:1447809777
Name:BOOT-HAURY, JARED WILLIAM (PSYD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:WILLIAM
Last Name:BOOT-HAURY
Suffix:
Gender:X
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 KING ST UNIT 122
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-1709
Mailing Address - Country:US
Mailing Address - Phone:734-604-0920
Mailing Address - Fax:
Practice Address - Street 1:351 KING ST UNIT 122
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-1709
Practice Address - Country:US
Practice Address - Phone:734-604-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5112-57103TC0700X
CAPSY35161103TC0700X
MI6301018026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health