Provider Demographics
NPI:1356737852
Name:BOONE, EMMA (PHD, LPC-S)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:BOONE
Suffix:
Gender:F
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 CROSSBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-8716
Mailing Address - Country:US
Mailing Address - Phone:601-672-7505
Mailing Address - Fax:601-502-1721
Practice Address - Street 1:2102 CROSSBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-8716
Practice Address - Country:US
Practice Address - Phone:601-672-7505
Practice Address - Fax:601-502-1721
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1945101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional