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General NPI Number Information
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NPI Number | 1407791700
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Entity Type | Individual
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Provider Name | LUKE THOMAS BOON
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Gender | Male
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Dates
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Enumeration Date | 04/22/2026
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Last Update Date | 04/22/2026
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Provider Practice Location Address
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Address Line | 10164 FORD AVE STE D
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City | RICHMOND HILL
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State | GA
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Zip | 31324-3948
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Country | US
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Telephone | 912-318-2690
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Fax | 912-318-2690
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Provider Business Mailing Address
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Address Line | 115 BOWRIDGE DR
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City | RICHMOND HILL
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State | GA
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Zip | 31324-7254
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Country | US
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Telephone | 912-318-2690
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Fax | 912-318-2690
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 061444673
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License Number State | GA
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