Healthcare Provider Details

I. General information

NPI: 1427302363
Provider Name (Legal Business Name): BOONE COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 CLIFTON AVE SUITE 200C
MINNEAPOLIS MN
55403-3235
US

IV. Provider business mailing address

314 CLIFTON AVE STE 200C
MINNEAPOLIS MN
55403-3226
US

V. Phone/Fax

Practice location:
  • Phone: 612-454-9798
  • Fax: 952-487-5234
Mailing address:
  • Phone: 612-454-9798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10413
License Number StateMN

VIII. Authorized Official

Name: ERIC FRANCIS BOONE
Title or Position: OWNER
Credential: LICSW
Phone: 612-454-9798