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General NPI Number Information
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NPI Number | 1043006935
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Entity Type | Organization
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Legal Business Name | THE CULTIVATE COMMUNITY, LLC
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 190 W STATE HIGHWAY 114 STE G
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City | SOUTHLAKE
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State | TX
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Zip | 76092-3612
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Country | US
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Telephone | 214-444-8539
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Fax |
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Provider Business Mailing Address
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Address Line | 300 STATE ST UNIT 92664
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1224
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CANDACE SZYMANSKI
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Credential | MT-BC
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Telephone | 847-624-0986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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