Provider Demographics
NPI:1184313918
Name:BOONE, SHANNA LYNN (MS CMHC)
Entity type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:LYNN
Last Name:BOONE
Suffix:
Gender:F
Credentials:MS CMHC
Other - Prefix:MRS
Other - First Name:SHANNA
Other - Middle Name:
Other - Last Name:BOONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC-A
Mailing Address - Street 1:3665 OLD HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9101
Mailing Address - Country:US
Mailing Address - Phone:956-801-2064
Mailing Address - Fax:
Practice Address - Street 1:3665 OLD HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-9101
Practice Address - Country:US
Practice Address - Phone:956-459-4685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health