MEDICARE: MR. LEE BOONE

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	32551	OTHER	CA	BIS

General Provider Information

NPI Number	:	1871617803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEE BOONE

Provider Business Mailing Address
First Line	:	PO BOX 767
Second Line	:
City	:	SUISUN CITY
State	:	CA
Zip	:	94585-0767
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2975 SACRAMENTO ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2534
Country	:	US
Telephone Number	:	415-740-5591
Fax Number	:

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	09/10/2015

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Directions to “ MR. LEE BOONE ” Practice Location

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