Basic Information
| Provider Information | |||||||||
| NPI: | 1316270788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOONE | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 355 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | KANAB | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847413260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356445811 | ||||||||
| FaxNumber: | 4356443588 | ||||||||
| Practice Location | |||||||||
| Address1: | 2205 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880053113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5759933201 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2009 | ||||||||
| LastUpdateDate: | 05/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | M-05398 | NM | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 11205780-3501 | UT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | I-07545 | NM | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.