Provider Demographics
NPI:1275719163
Name:BOONE, JENNIFER PAYNE (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PAYNE
Last Name:BOONE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61141 S HWY 97 # 637
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2523
Mailing Address - Country:US
Mailing Address - Phone:541-728-7375
Mailing Address - Fax:
Practice Address - Street 1:61050 SYDNEY HARBOR DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-728-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC2746OtherLICENSED PROFESSIONAL COUNSLOR