Healthcare Provider Details

I. General information

NPI: 1538875588
Provider Name (Legal Business Name): JESSICA BOONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 MONTLIMAR DR
MOBILE AL
36609-1713
US

IV. Provider business mailing address

1313 SCHILLINGER RD S APT 2409
MOBILE AL
36695-8997
US

V. Phone/Fax

Practice location:
  • Phone: 251-450-2250
  • Fax:
Mailing address:
  • Phone: 251-481-9026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC05671
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: