Provider Demographics
NPI:1952621591
Name:AUDRA D BOXMA PA
Entity Type:Organization
Organization Name:AUDRA D BOXMA PA
Other - Org Name:LIFE SKILLS COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHILD/FAMILY COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOXMA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,NCC,CCMHC,CART
Authorized Official - Phone:817-416-2344
Mailing Address - Street 1:700 E SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6353
Mailing Address - Country:US
Mailing Address - Phone:817-416-2344
Mailing Address - Fax:
Practice Address - Street 1:700 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6353
Practice Address - Country:US
Practice Address - Phone:817-416-2344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-06
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16596251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health