Provider Demographics
NPI:1598590747
Name:BOONE, ALICIA (PCLC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BOONE
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 S BLACK AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4150 VALLEY COMMONS DR STE B
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6407
Practice Address - Country:US
Practice Address - Phone:406-207-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-13
Deactivation Date:2024-09-06
Deactivation Code:
Reactivation Date:2024-09-13
Provider Licenses
StateLicense IDTaxonomies
MT72566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional