MEDICARE: GEORGIA BOXER THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1154258101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA BOXER THERAPY PLLC

Provider Business Mailing Address
First Line	:	938 EDGEMERE CT
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-1429
Country	:	US
Telephone Number	:	773-245-3625
Fax Number	:

Provider Business Practice Location Address
First Line	:	938 EDGEMERE CT
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-1429
Country	:	US
Telephone Number	:	773-245-3625
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST, OWNER/OPERATOR
Name	:	GEORGIA BOXER
Credential	:	LCPC
Telephone Number	:	773-245-3625

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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