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General NPI Number Information
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NPI Number | 1023691490
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Entity Type | Organization
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Legal Business Name | CULTIVATE MENTAL HEALTH PC
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 11164 CHEROKEE ST
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City | NORTHGLENN
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State | CO
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Zip | 80234-3918
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Country | US
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Telephone | 303-918-9828
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Fax | 303-529-3167
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Provider Business Mailing Address
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Address Line | 11164 CHEROKEE ST
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City | NORTHGLENN
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State | CO
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Zip | 80234-3918
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Country | US
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Telephone | 303-918-9828
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Fax | 303-529-3167
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TANYA TANNER
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Credential | PHD MBA CNM PMHNP-BC
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Telephone | 303-918-9828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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