Provider Demographics
NPI:1225356363
Name:SBX TX OTB, PLLC
Entity Type:Organization
Organization Name:SBX TX OTB, PLLC
Other - Org Name:THERAPY OUTSIDE THE BOX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HASTINGS
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-209-2305
Mailing Address - Street 1:PO BOX 1050
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423
Mailing Address - Country:US
Mailing Address - Phone:859-209-2295
Mailing Address - Fax:859-236-5152
Practice Address - Street 1:106 BELINDA BLVD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:859-209-2320
Practice Address - Fax:859-209-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100151790Medicaid
P100025976Medicare PIN
KYP100025976Medicare PIN