Individual
MICKEY SCOTT BOONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1305 CUMBERLAND AVE STE 110, WEST LAFAYETTE, IN 47906-1316
(765) 464-2991
Mailing address
1305 CUMBERLAND AVE STE 225, WEST LAFAYETTE, IN 47906-1343
(765) 464-2991
(765) 436-5509
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/15/2021
Last updated
06/15/2021
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