Provider Demographics
NPI:1235580580
Name:BOONE-BLACK, CATHY
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:BOONE-BLACK
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 1:5716 KENYON TRL
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-6950
Mailing Address - Country:US
Mailing Address - Phone:317-507-1463
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL DR
Practice Address - Street 2:SUITE C2B
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2918
Practice Address - Country:US
Practice Address - Phone:317-507-1463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor