MEDICARE: LATRISA BOONE-LANIER MBA, CBHCM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency		FL
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1417205394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATRISA BOONE-LANIER MBA, CBHCM

Provider Business Mailing Address
First Line	:	33867 CASTAWAY LOOP
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-7353
Country	:	US
Telephone Number	:	813-892-8905
Fax Number	:

Provider Business Practice Location Address
First Line	:	33867 CASTAWAY LOOP
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-7353
Country	:	US
Telephone Number	:	813-892-8905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	02/06/2026

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