Provider Demographics
NPI:1740972264
Name:BOONE, MARNITA LYNETTE (MA PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:MARNITA
Middle Name:LYNETTE
Last Name:BOONE
Suffix:
Gender:F
Credentials:MA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1504 CROCKETT GARDENS RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4033
Mailing Address - Country:US
Mailing Address - Phone:770-377-2954
Mailing Address - Fax:770-377-2954
Practice Address - Street 1:1504 CROCKETT GARDENS RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-4033
Practice Address - Country:US
Practice Address - Phone:770-377-2954
Practice Address - Fax:770-377-2954
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor