Provider Demographics
NPI:1689329138
Name:BOONE FAMILY THERAPY, PLLC
Entity Type:Organization
Organization Name:BOONE FAMILY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:561-373-0852
Mailing Address - Street 1:181 CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-3716
Mailing Address - Country:US
Mailing Address - Phone:561-373-0852
Mailing Address - Fax:
Practice Address - Street 1:805 STATE FARM RD STE 304
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4914
Practice Address - Country:US
Practice Address - Phone:561-373-0852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty