MEDICARE: MR. TOMMY AARON BOONE LPC

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	101YP2500X	Professional Counselor	002955	GA

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	:	1457451007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOMMY AARON BOONE LPC

Provider Business Mailing Address
First Line	:	1167 HIGHFIELD DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-4678
Country	:	US
Telephone Number	:	678-313-3549
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 PEACHFORD RD
Second Line	:	SUITE H
City	:	ATLANTA
State	:	GA
Zip	:	30338-6520
Country	:	US
Telephone Number	:	770-932-7000
Fax Number	:	404-793-0149

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

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	07/12/2015

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