| Out The Box Therapy Llc | |
|
5215 Bradmore Ln Warren MI 48092-6322 | |
| (734) 678-1363 | |
| Not Available |
| Full Name | Out The Box Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5215 Bradmore Ln, Warren, Michigan |
| Authorized Official Name and Position | Clara Throckmorton (OWNER) |
| Authorized Official Contact | 7346781363 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Out The Box Therapy Llc 921 Lulworth Ln Lawrenceville GA 30044-2760 Ph: (734) 678-1363 | Out The Box Therapy Llc 5215 Bradmore Ln Warren MI 48092-6322 Ph: (734) 678-1363 |
| NPI Number | 1265284798 |
|---|---|
| Provider Enumeration Date | 04/05/2024 |
| Last Update Date | 10/01/2024 |
| Certification Date | 10/01/2024 |
| Medicare PECOS PAC ID | 2163953225 |
|---|---|
| Medicare Enrollment ID | O20241001001752 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265284798 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Clara Throckmorton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477827830 PECOS PAC ID: 8921380304 Enrollment ID: I20220519002640 |
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