Provider Demographics
NPI:1538843164
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:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOX
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:601-278-4818
Mailing Address - Street 1:1801 CRANE RIDGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4987
Mailing Address - Country:US
Mailing Address - Phone:601-278-4818
Mailing Address - Fax:
Practice Address - Street 1:1801 CRANE RIDGE DR STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4987
Practice Address - Country:US
Practice Address - Phone:601-278-4818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty