Outsidethebox Detroit Therapy

Primary specialty

Social WorkerTaxonomy code 104100000X

Legal business name

OUTSIDETHEBOX DETROIT THERAPY

Practice address

4131 Clippert St
Dearborn HTS, MI 48125-2732

Phone

(313) 680-0019

NPI assigned

Nov 18, 2024

Last updated

Nov 18, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bradley Allan Lake, LMSWNPI 1083261705

Title

Ceo/Therapist

Phone

(313) 680-0019

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bradley Allan Lake, LMSW

  • Social Worker
  • Detroit, MI
  • NPI 1083261705
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731888000000",
    "number": "1003631987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23131 MICHIGAN AVE # 1046",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242020",
            "telephone_number": "313-680-0019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4131 CLIPPERT ST",
            "city": "DEARBORN HTS",
            "state": "MI",
            "postal_code": "481252732",
            "telephone_number": "313-680-0019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTSIDETHEBOX DETROIT THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-18",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-17",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "CEO/THERAPIST",
        "authorized_official_telephone_number": "313-680-0019",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Social Worker in Dearborn HTS, MI
• Providers in Dearborn HTS, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.