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:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:LARKE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:864-597-2054
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 1:115 E MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-3017
Practice Address - Country:US
Practice Address - Phone:864-597-2054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5222251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1250Medicaid