MEDICARE: BOONE MARTIN MITCHELL

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	95927	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95927	OTHER	TX	LPC

General Provider Information

NPI Number	:	1881540052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOONE MARTIN MITCHELL

Provider Business Mailing Address
First Line	:	5643 CIELO RNCH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-4165
Country	:	US
Telephone Number	:	325-513-6016
Fax Number	:

Provider Business Practice Location Address
First Line	:	5643 CIELO RNCH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-4165
Country	:	US
Telephone Number	:	325-513-6016
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

Similar Medicare Providers

1609160837 — HILLARY HUNT MS CCC-SLP
Practice Location Address:

136 PINECREST BLVD , #4
SAN ANTONIO, TX
78209-4165

Practice Phone: 210-875-9393
Practice Fax:

1033639992 — JIMMY DALE STEWART LVN
Practice Location Address:

9931 HYATT RESORT DR APT 231
SAN ANTONIO, TX
78251-4165

Practice Phone: 210-231-0038
Practice Fax: 210-231-0038

1992644207 — ADRIANA LIIMAKKA
Practice Location Address:

444 S SAN VICENTE BLVD
LOS ANGELES, CA
90048-4165

Practice Phone: 310-423-9779
Practice Fax:

1033064126 — JULIE FORMICA
Practice Location Address:

2118 HILLCREST RD
SAN PABLO, CA
94806-4165

Practice Phone: 510-396-2920
Practice Fax:

1033119250 — DR. JASON A BERKLEY D.O.
Practice Location Address:

444 S SAN VICENTE BLVD , 800
LOS ANGELES, CA
90048-4165

Practice Phone: 310-423-9900
Practice Fax: 310-423-9965

1801897012 — MICK SCOTT MEISELMAN MD
Practice Location Address:

1304 ELLA ST STE A
SAN LUIS OBISPO, CA
93401-4165

Practice Phone: 805-549-9555
Practice Fax: 805-549-0444

Directions to “ BOONE MARTIN MITCHELL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.