Healthcare Provider Details

I. General information

NPI: 1598590747
Provider Name (Legal Business Name): ALICIA BOONE PCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 07/26/2025
Certification Date: 07/26/2025
Deactivation Date: 09/06/2024
Reactivation Date: 09/13/2024

III. Provider practice location address

4150 VALLEY COMMONS DR STE B
BOZEMAN MT
59718-6407
US

IV. Provider business mailing address

1922 S BLACK AVE
BOZEMAN MT
59715-5708
US

V. Phone/Fax

Practice location:
  • Phone: 406-207-9902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number72566
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number72566
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: