Provider Demographics
NPI:1558012286
Name:SPRINGBOX THERAPY LLC
Entity type:Organization
Organization Name:SPRINGBOX THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGEANNA
Authorized Official - Middle Name:INGERSOLL
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-239-2796
Mailing Address - Street 1:3217 HENNEPIN AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4695
Mailing Address - Country:US
Mailing Address - Phone:612-239-2796
Mailing Address - Fax:888-971-3874
Practice Address - Street 1:3217 HENNEPIN AVE STE 5
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4695
Practice Address - Country:US
Practice Address - Phone:612-239-2796
Practice Address - Fax:888-971-3874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health