Healthcare Provider Details

I. General information

NPI: 1427902808
Provider Name (Legal Business Name): CULTIVATE NW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18220 BALLINGER WAY NE
LAKE FOREST PARK WA
98155-4237
US

IV. Provider business mailing address

18220 BALLINGER WAY NE
LAKE FOREST PARK WA
98155-4237
US

V. Phone/Fax

Practice location:
  • Phone: 425-417-8075
  • Fax:
Mailing address:
  • Phone: 425-417-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARCUS COMER
Title or Position: MARRIAGE & FAMILY THERAPIST ASSOC.
Credential: LMFTA
Phone: 425-417-8075