Healthcare Provider Details

I. General information

NPI: 1023710753
Provider Name (Legal Business Name): CULTIVATE LIFE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 S PEARL ST STE 10
DENVER CO
80210-3159
US

IV. Provider business mailing address

PO BOX 5476
GREENWOOD VILLAGE CO
80155-5410
US

V. Phone/Fax

Practice location:
  • Phone: 720-277-9854
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: JESSE BAILEY
Title or Position: OWNER, THERAPIST
Credential:
Phone: 720-277-9854