MEDICARE: MARNITA LYNETTE BOONE MA PSYCHOLOGY

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1740972264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARNITA LYNETTE BOONE MA PSYCHOLOGY

Provider Business Mailing Address
First Line	:	1504 CROCKETT GARDENS RD
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-4033
Country	:	US
Telephone Number	:	770-377-2954
Fax Number	:	770-377-2954

Provider Business Practice Location Address
First Line	:	1504 CROCKETT GARDENS RD
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-4033
Country	:	US
Telephone Number	:	770-377-2954
Fax Number	:	770-377-2954

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

Provider Enumeration Date	:	05/23/2023
Last Update Date	:	05/23/2023

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