Provider Demographics
NPI:1417038233
Name:BOONE, MARY H (LCSW, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:H
Last Name:BOONE
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5207 ENCINITAS LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-2921
Mailing Address - Country:US
Mailing Address - Phone:512-826-8348
Mailing Address - Fax:512-732-2430
Practice Address - Street 1:3355 BEE CAVE RD
Practice Address - Street 2:SUITE 601
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6775
Practice Address - Country:US
Practice Address - Phone:512-826-8348
Practice Address - Fax:512-732-2430
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX377431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical