Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Sam Booth, MA

Individual provider Mental Health Counselor · NPI 1063380475

Sam Booth, MA is a Mental Health Counselor in Fort Wayne, Indiana. Practices as a sole proprietor. Registered with an NPI since 2025.

In the registry since
2025
What do these letters mean?
MA — Master of Arts
A graduate arts degree.

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Practice location Address checks out

9329 Illinois Rd
Fort Wayne, IN 46804-5796
Phone: (260) 444-6045
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X

Record details

NPI number1063380475
Entity typeIndividual (Type 1)
GenderMale
Credentials MA
Sole proprietorYes
NPI enumeratedOctober 27, 2025
Last updated in NPPESOctober 27, 2025
Certification dateOctober 27, 2025
Mailing address9329 Illinois Rd, Fort Wayne, IN 46804-5796

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