Provider Demographics
NPI:1366842692
Name:OUT OF THE BOX THERAPY, LLC
Entity Type:Organization
Organization Name:OUT OF THE BOX THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:
Authorized Official - First Name:ZIV
Authorized Official - Middle Name:
Authorized Official - Last Name:BEN-DOV
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:570-209-7998
Mailing Address - Street 1:321 SPRUCE ST
Mailing Address - Street 2:SUITE 511
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1400
Mailing Address - Country:US
Mailing Address - Phone:570-209-7998
Mailing Address - Fax:570-955-0774
Practice Address - Street 1:321 SPRUCE ST
Practice Address - Street 2:SUITE 511
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1400
Practice Address - Country:US
Practice Address - Phone:570-209-7998
Practice Address - Fax:570-955-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005186101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty