Boone Leonard Benton, PH.D., LPC
Individual provider Active NPI Professional Counselor · Jasper, GA
NPI 1104506294 · NPPES record last updated Jul 24, 2023
Key facts
- NPI
- 1104506294
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 001999 (GA)
- Practice address
- 376 Tally Mountain Rd N
Jasper, GA 30143-4706 - Phone
- (770) 846-8161
- NPI assigned
- Jul 24, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | 001999 | GA | Yes |
Addresses
Primary practice location
376 Tally Mountain Rd N
Jasper, GA 30143-4706
Mailing address
376 Tally Mountain Rd N
Jasper, GA 30143-4706
Phone (770) 846-8161
Other providers in Jasper, GA
- Bearing Burdens, LLC
- Joseph Randall Page Beaugh
- Hannah Marie Bell
- Maria Bencsath
- Kristin Seals Benefield
- Jason Andrew Berner
- Jordan Best
- Hershel Bhadsavle
- Birchwood Counseling LLC
- Julia Bishop
All providers in Jasper, GA · Professional Counselor in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.