Healthcare Provider Details

I. General information

NPI: 1811602766
Provider Name (Legal Business Name): ANNA BOONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 DIXIE HWY
HAMILTON OH
45015-1653
US

IV. Provider business mailing address

3103 DIXIE HWY
HAMILTON OH
45015-1653
US

V. Phone/Fax

Practice location:
  • Phone: 513-892-4673
  • Fax:
Mailing address:
  • Phone: 513-892-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCDCA.180648
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.003365
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: