Provider Demographics
NPI:1962731679
Name:BOONE, LARRY D (RTC)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:BOONE
Suffix:
Gender:M
Credentials:RTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001A EAST PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2501
Mailing Address - Country:US
Mailing Address - Phone:916-876-5675
Mailing Address - Fax:916-875-6705
Practice Address - Street 1:7001A EAST PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2501
Practice Address - Country:US
Practice Address - Phone:916-876-5675
Practice Address - Fax:916-875-6705
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor