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General NPI Number Information
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NPI Number | 1043907231
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Entity Type | Organization
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Legal Business Name | CULTIVATE MENTAL HEALTH
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Dates
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Enumeration Date | 04/19/2023
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 325 TENAHA ST
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City | CENTER
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State | TX
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Zip | 75935-3446
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Country | US
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Telephone | 936-488-9056
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Fax |
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Provider Business Mailing Address
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Address Line | 325 TENAHA ST
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City | CENTER
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State | TX
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Zip | 75935-3446
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Country | US
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Telephone | 936-488-9056
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. DAN FELTON WILKINS
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Credential | D.R.
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Telephone | 936-488-9056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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