MEDICARE: BOONE COUNSELING SERVICES, PLLC

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	1041C0700X	Clinical Social Worker	10413	MN
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427302363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOONE COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	314 CLIFTON AVE STE 200C
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3226
Country	:	US
Telephone Number	:	612-454-9798
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 CLIFTON AVE
Second Line	:	SUITE 200C
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3235
Country	:	US
Telephone Number	:	612-454-9798
Fax Number	:	952-487-5234

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC FRANCIS BOONE
Credential	:	LICSW
Telephone Number	:	612-454-9798

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	06/13/2022

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