Provider Demographics
NPI:1942470240
Name:M. BOONE & ASSOCIATES
Entity Type:Organization
Organization Name:M. BOONE & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:LEVELLE
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMSW BCD
Authorized Official - Phone:313-682-7186
Mailing Address - Street 1:1139 BROOKLINE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3233
Mailing Address - Country:US
Mailing Address - Phone:313-682-7186
Mailing Address - Fax:734-981-1040
Practice Address - Street 1:1139 BROOKLINE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3233
Practice Address - Country:US
Practice Address - Phone:313-682-7186
Practice Address - Fax:734-981-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801016250251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health