Provider Demographics
NPI:1669665923
Name:BOONE, RICHARD R (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:BOONE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 S WS YOUNG DRIVE
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-3374
Mailing Address - Country:US
Mailing Address - Phone:254-252-3748
Mailing Address - Fax:254-549-0086
Practice Address - Street 1:3800 S WS YOUNG DRIVE
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542
Practice Address - Country:US
Practice Address - Phone:254-252-3748
Practice Address - Fax:254-549-0086
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV663103TC0700X
TX36906103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical