Provider Demographics
NPI:1265284798
Name:OUT THE BOX THERAPY LLC
Entity type:Organization
Organization Name:OUT THE BOX THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:THROCKMORTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:734-678-1363
Mailing Address - Street 1:921 LULWORTH LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2760
Mailing Address - Country:US
Mailing Address - Phone:734-678-1363
Mailing Address - Fax:
Practice Address - Street 1:5215 BRADMORE LN
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-6322
Practice Address - Country:US
Practice Address - Phone:734-678-1363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty