=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386190288
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUTSIDE OF THE BOX THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2016
-----------------------------------------------------
Last Update Date | 07/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 W MEADOW ST
-----------------------------------------------------
City | GAFFNEY
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29341-2350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-597-9493
-----------------------------------------------------
Fax | 864-206-4563
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 170581
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29301-0029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-597-2054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | CHRISTIE ROGERS LARKE
-----------------------------------------------------
Credential | ED.D
-----------------------------------------------------
Telephone | 864-597-9493
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 5222
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------