MEDICARE: MRS. AMANDA ROBERSON BOYLES M.ED., LPC

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	101YS0200X	School Counselor		GA
2	101YP2500X	Professional Counselor	LPC013072	GA

General Provider Information

NPI Number	:	1780424762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA ROBERSON BOYLES M.ED., LPC

Provider Business Mailing Address
First Line	:	326 MYRTLE CROSSING DR
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-4688
Country	:	US
Telephone Number	:	912-690-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	326 MYRTLE CROSSING DR
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-4688
Country	:	US
Telephone Number	:	912-489-7590
Fax Number	:	912-489-3877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2024
Last Update Date	:	05/28/2024

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