Provider Demographics
NPI:1184169054
Name:BOONE, CLARICE NICOLE (MAED)
Entity type:Individual
Prefix:
First Name:CLARICE
Middle Name:NICOLE
Last Name:BOONE
Suffix:
Gender:
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 NW MARKET ST STE 307
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4047
Mailing Address - Country:US
Mailing Address - Phone:206-627-0062
Mailing Address - Fax:
Practice Address - Street 1:2208 NW MARKET ST STE 307
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4047
Practice Address - Country:US
Practice Address - Phone:206-627-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2025-03-31
Deactivation Date:2023-08-18
Deactivation Code:
Reactivation Date:2023-08-30
Provider Licenses
StateLicense IDTaxonomies
WALH61655445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health