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General NPI Number Information
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NPI Number | 1982814893
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Entity Type | Organization
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Legal Business Name | JAMES R BOONE PH D PROFESSIONAL LLC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 2625 KEYSTONE RD SUITE A-3
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City | TARPON SPRINGS
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State | FL
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Zip | 34688-7436
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Country | US
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Telephone | 727-944-4600
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Fax | 727-945-9800
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Provider Business Mailing Address
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Address Line | 2625 KEYSTONE RD SUITE A-3
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City | TARPON SPRINGS
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State | FL
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Zip | 34688-7436
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Country | US
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Telephone | 727-944-4600
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Fax | 727-945-9800
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JAMES RICHARDSON BOONE
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Credential | PH.D.
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Telephone | 727-944-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY04361
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License Number State | FL
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