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SAM BOOTH M.A.
NPI 1063380475
Counselor - Mental Health in Fort Wayne, IN

Active since October 27, 2025
9329 ILLINOIS RD, FORT WAYNE, IN 46804(260) 444-6045 Get Directions Write a Review

NPPES record last updated: October 27, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Sam Booth M.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAM BOOTH M.A. (NPI 1063380475) is an individual mental health provider in Fort Wayne, Indiana and active in the NPI registry since October 2025.

NPPES Registry Identity

NPI1063380475
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameSAM BOOTHCredential: M.A.
Location Address9329 ILLINOIS RDFort Wayne, IN 46804-5796
Mailing Address9329 Illinois RdFort Wayne, IN 46804-5796 · (260) 444-6045
Phone(260) 444-6045
Sole ProprietorYes
Enumeration DateOctober 27, 2025
NPPES CertifiedOctober 27, 2025
✔ NPI 1063380475 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
9329 ILLINOIS RD, Fort Wayne, IN 46804
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. DAVID LEE KURTZ MSW, LSW
Social Worker
9329 ILLINOIS RD
FORT WAYNE, IN 46804
Allen County (260) 204-0001
PEOPLE AND PATHWAYS CONSULTING LLC
Community/Behavioral Health
9329 ILLINOIS RD
FORT WAYNE, IN 46804
Allen County (260) 204-0001
BOOTH & COMPANY, INC.
Psychologist (Clinical)
9329 ILLINOIS RD
FORT WAYNE, IN 46804
Allen County (260) 755-5896
DR. SPENCER JENKINS BOOTH PSYD, HSPP
Psychologist (Clinical)
9329 ILLINOIS RD
FORT WAYNE, IN 46804
Allen County (260) 417-4885
JAY BASTIAN LLC
Social Worker (Clinical)
9329 ILLINOIS RD
FORT WAYNE, IN 46804
Allen County (260) 418-9653
JAY ALAN BASTIAN LCSW
Social Worker
9329 ILLINOIS RD
FORT WAYNE, IN 46804
Allen County (260) 418-9653

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sam Booth's NPI number?

The NPI number for Sam Booth is 1063380475. It was assigned to this individual provider in the NPPES registry on October 27, 2025.

Where is Sam Booth located?

Sam Booth practices at 9329 Illinois Rd, Fort Wayne, IN 46804. The listed phone number is (260) 444-6045.

What is Sam Booth's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Sam Booth was last updated on October 27, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.