Provider Demographics
NPI:1750457792
Name:BOEWE, MONA (MC, LAC)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:
Last Name:BOEWE
Suffix:
Gender:F
Credentials:MC, LAC
Other - Prefix:MS
Other - First Name:MONA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5633 S SAILORS REEF RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2135
Mailing Address - Country:US
Mailing Address - Phone:480-361-3398
Mailing Address - Fax:
Practice Address - Street 1:2346 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1329
Practice Address - Country:US
Practice Address - Phone:602-271-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health