Provider Demographics
NPI:1477931087
Name:BOONE, PEGGY (PHD)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:
Last Name:BOONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30242 POST OAK RUN
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-4640
Mailing Address - Country:US
Mailing Address - Phone:832-521-3492
Mailing Address - Fax:
Practice Address - Street 1:30242 POST OAK RUN
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-4640
Practice Address - Country:US
Practice Address - Phone:832-521-3492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health