Provider Demographics
NPI:1144599481
Name:LARBI-BOAMAH, JOSEPHINE
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:
Last Name:LARBI-BOAMAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6821
Mailing Address - Country:US
Mailing Address - Phone:877-800-5722
Mailing Address - Fax:
Practice Address - Street 1:2112 SW H K DODGEN LOOP STE 110
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7011
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:860-231-8449
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor