Provider Demographics
NPI:1760869549
Name:BOONE, JANIS REBECCA (MA, LPC, ISSP, NCC)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:REBECCA
Last Name:BOONE
Suffix:
Gender:F
Credentials:MA, LPC, ISSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 N WEBER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1049
Mailing Address - Country:US
Mailing Address - Phone:719-800-1645
Mailing Address - Fax:
Practice Address - Street 1:731 N WEBER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1049
Practice Address - Country:US
Practice Address - Phone:719-800-1645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012429101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional