Provider Demographics
NPI:1417282567
Name:BOXMA, AUDRA (LMHC,CCMHC,NCC,CTMH)
Entity Type:Individual
Prefix:MS
First Name:AUDRA
Middle Name:
Last Name:BOXMA
Suffix:
Gender:F
Credentials:LMHC,CCMHC,NCC,CTMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631278
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1278
Mailing Address - Country:US
Mailing Address - Phone:941-485-0121
Mailing Address - Fax:
Practice Address - Street 1:2574 COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34289-9334
Practice Address - Country:US
Practice Address - Phone:941-485-0121
Practice Address - Fax:941-485-0591
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11321101YM0800X
FL973101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional