Provider Demographics
NPI:1386190288
Name:OUTSIDE OF THE BOX THERAPY
Entity type:Organization
Organization Name:OUTSIDE OF THE BOX THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLININCAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS LARKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCS
Authorized Official - Phone:864-597-9493
Mailing Address - Street 1:PO BOX 170581
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-0029
Mailing Address - Country:US
Mailing Address - Phone:864-597-2054
Mailing Address - Fax:
Practice Address - Street 1:206 W MEADOW ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2350
Practice Address - Country:US
Practice Address - Phone:864-597-9493
Practice Address - Fax:864-206-4563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
SC5222251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1250Medicaid