Issac Luther Boose Jr., LPC, LMFT
Individual provider Active NPI Counselor · Richton, MS
NPI 1992393318 · NPPES record last updated Jan 3, 2021
Key facts
- NPI
- 1992393318
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 883 (MS)
- Practice address
- 57 Griffin Rd
Richton, MS 39476-9224 - Phone
- (601) 408-8828
- NPI assigned
- Jan 3, 2021
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 883 | MS | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 883 | MS | Yes |
Addresses
Primary practice location
57 Griffin Rd
Richton, MS 39476-9224
Mailing address
57 Griffin Rd
Richton, MS 39476-9224
Phone (601) 408-8828
Other names
- Mr. Issac Luther Boose Jr.
Other providers in Richton, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2021. 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.