Healthcare Provider Details

I. General information

NPI: 1174198345
Provider Name (Legal Business Name): CULTIVATE HOPE KC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 COLLEGE BLVD
LEAWOOD KS
66211-1932
US

IV. Provider business mailing address

5001 COLLEGE BLVD
LEAWOOD KS
66211-1932
US

V. Phone/Fax

Practice location:
  • Phone: 913-318-4679
  • Fax:
Mailing address:
  • Phone: 913-318-4679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MELISSA TRACY
Title or Position: OWNER
Credential: LCPC
Phone: 913-318-4679