Provider Demographics
NPI:1427302363
Name:BOONE COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:BOONE COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-454-9798
Mailing Address - Street 1:314 CLIFTON AVE STE 200C
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3226
Mailing Address - Country:US
Mailing Address - Phone:612-454-9798
Mailing Address - Fax:
Practice Address - Street 1:314 CLIFTON AVE
Practice Address - Street 2:SUITE 200C
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3235
Practice Address - Country:US
Practice Address - Phone:612-454-9798
Practice Address - Fax:952-487-5234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN104131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1982702981Medicaid
MN1982702981Medicaid