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General NPI Number Information
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NPI Number | 1982768693
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Entity Type | Individual
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Provider Name | BETH BOONE PH.D
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Gender | Female
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/05/2019
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Provider Practice Location Address
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Address Line | 14448 BRUCE B DOWNS BLVD
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City | TAMPA
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State | FL
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Zip | 33613-2612
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Country | US
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Telephone | 813-701-2471
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Fax | 813-701-2471
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Provider Business Mailing Address
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Address Line | 6 S DRAGONWOOD PL
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City | THE WOODLANDS
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State | TX
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Zip | 77381-6128
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Country | US
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Telephone | 328-257-0318
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 14063
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY10428
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License Number State | FL
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