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General NPI Number Information
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NPI Number | 1588485098
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Entity Type | Organization
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Legal Business Name | GROWING MINDS OUTSIDE THE BOX
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 2176 PARK AVE STE 102
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City | ORANGE PARK
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State | FL
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Zip | 32073-5586
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Country | US
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Telephone | 678-400-7379
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Fax |
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Provider Business Mailing Address
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Address Line | 5860 HILDERBRAND DR
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City | ATLANTA
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State | GA
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Zip | 30328-5149
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Country | US
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Telephone | 856-656-1258
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. EFE ODELEYE
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Credential | MPA
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Telephone | 856-656-1258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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