Provider Demographics
NPI:1346367026
Name:BOONE, TONYA M (LCSW)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:M
Last Name:BOONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:S
Other - Last Name:MCMILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8823 W FARM ROAD 34
Mailing Address - Street 2:WALNUT GROVE
Mailing Address - City:WALNUT GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65770-2889
Mailing Address - Country:US
Mailing Address - Phone:417-224-3432
Mailing Address - Fax:
Practice Address - Street 1:1644 W ELFINDALE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1286
Practice Address - Country:US
Practice Address - Phone:417-224-3432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0049551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPENDINGMedicaid
MOPENDINGMedicaid