Provider Demographics
NPI:1497313514
Name:BETH C. BOONE, PH.D., PLLC
Entity Type:Organization
Organization Name:BETH C. BOONE, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:832-257-0318
Mailing Address - Street 1:PARAGON COUNSELING - 14448 BRUCE B DOWNS BLVD FL 33613
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2612
Mailing Address - Country:US
Mailing Address - Phone:813-701-2471
Mailing Address - Fax:813-701-2471
Practice Address - Street 1:PARAGON COUNSELING - 14448 BRUCE B DOWNS BLVD FL 33613
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2612
Practice Address - Country:US
Practice Address - Phone:813-701-2471
Practice Address - Fax:813-701-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty